WorldWideScience

Sample records for medicare program proposed

  1. 76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

    Science.gov (United States)

    2011-04-15

    ...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions.... 111-148, enacted on March 23, 2010) (Affordable Care Act) authorized the Medicare Community-based Care...

  2. 77 FR 29647 - Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education...

    Science.gov (United States)

    2012-05-18

    ...] Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education Demonstration... participate in the Medicare Graduate Nurse Education (GNE) Demonstration. DATES: Proposals will be considered...--(A) 1 or more applicable schools of nursing; and (B) 2 or more applicable non- hospital community...

  3. 77 FR 16841 - Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education...

    Science.gov (United States)

    2012-03-22

    ...] Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education Demonstration... Education (GNE) Demonstration. The primary goal of the GNE Demonstration is to increase the number of... schools of nursing; and (B) 2 or more applicable non-hospital community-based care settings. The written...

  4. 76 FR 63017 - Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug...

    Science.gov (United States)

    2011-10-11

    ... (Sec. 423.2300) b. Definitions (Sec. 423.2305) (1) Applicable Beneficiary (2) Applicable Drug (3... marketing, including agent/broker training; payments to MA organizations based on quality ratings; standards... program; payment rules for non-contract health care providers; extending current network adequacy...

  5. 76 FR 34633 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

    Science.gov (United States)

    2011-06-14

    ..., 413, and 476 [CMS-1518-CN] RIN 0938-AQ24 Medicare Program; Proposed Changes to the Hospital Inpatient...-9644 of May 5, 2011 (76 FR 25788), there were a number of technical and typographical errors that are...) endorsement number for the CMS quality measure, Percent of Residents With Pressure Ulcers That Are New or...

  6. 75 FR 72830 - Medicare Program; Quality Improvement Organization (QIO) Contracts: Solicitation of Proposals...

    Science.gov (United States)

    2010-11-26

    ...] Medicare Program; Quality Improvement Organization (QIO) Contracts: Solicitation of Proposals From In-State... the Social Security Act (the Act) to provide at least 6 months' advance notice of the expiration dates of contracts with out- of-State Quality Improvement Organizations (QIOs) before renewing any of those...

  7. Medicare program; revision to accrual basis of accounting policy--HCFA. Proposed rule.

    Science.gov (United States)

    1998-05-18

    Current policy provides that payroll taxes a provider becomes obligated to remit to governmental agencies are included in allowable costs under Medicare only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in one year but not paid until the next year, the associated payroll taxes on the payroll are not an allowable cost until the next year. This proposed rule would make one exception, in the situation where payment would be made to the employee in the current year but for the fact the regularly scheduled payment date is after the end of the year. In that case, the rule would require allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this proposal is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on and-of-the-year payroll would be allowable in the current period rather than in the following period.

  8. 75 FR 46169 - Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and CY...

    Science.gov (United States)

    2010-08-03

    ... hospitalization and community mental health center issues. James Poyer, (410) 786-2261, Reporting of quality data... Community mental health center CMS Centers for Medicare & Medicaid Services CoP Conditions of Participation... (which includes partial hospitalization services furnished by community mental health centers (CMHCs...

  9. 76 FR 41178 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

    Science.gov (United States)

    2011-07-13

    ... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...

  10. 75 FR 23851 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

    Science.gov (United States)

    2010-05-04

    ... Diagnoses for Current HACs g. Preliminary RTI Analysis of Estimated Net Savings for Current HACs h... MIEA-TRHCA a. Reclassification Average Hourly Wage Comparison Criteria b. Budget Neutrality Adjustment....--Proposed Rural Floor Budget Neutrality Factors for Acute Care Hospitals--FY 2011 Table 4D-2.--Urban Areas...

  11. 77 FR 23193 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2; Corrections

    Science.gov (United States)

    2012-04-18

    ..., 413, and 495 [CMS-0044-CN] RIN 0938-AQ84 Medicare and Medicaid Programs; Electronic Health Record... proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record Incentive Program--Stage... (77 FR 13698), the proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record...

  12. Medicare depreciation; useful life guidelines--HCFA. Proposed rule.

    Science.gov (United States)

    1982-09-30

    We are proposing to amend Medicare regulations to clarify which useful life guidelines providers of health care services may use to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize HHS useful life guidelines or, if none have been published by HHS, the American Hospital Association (AHA) useful life guidelines of 1973 or IRS guidelines. We are proposing to eliminate the reference to IRS guidelines because those previously acceptable for Medicare purposes are outdated and have been made obsolete by the IRS or by statutory change. We would also delete the specific reference to the 1973 AHA guidelines. In addition, we intend this amendment to clarify that certain tax legislation on accelerated depreciation, recently passed by Congress, does not apply to the Medicare program.

  13. 78 FR 43820 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Science.gov (United States)

    2013-07-22

    ... and 423 [CMS-4173-CN] RIN 0938-AR69 Medicare Program; Medical Loss Ratio Requirements for the Medicare... number of technical, typographical, and cross-referencing errors that are identified and corrected in the... Minimum Medical Loss Ratio, we made a typographical error in a section number. On page 31311, in Sec. 423...

  14. Medicare program; acquisition, protection and disclosure of utilization and quality control peer review organization (PRO) information--HCFA. Proposed rule.

    Science.gov (United States)

    1984-04-16

    This proposal would govern the acquisition, protection and disclosure of information obtained or generated by Utilization and Quality Control Peer Review Organizations (PROs). The Peer Review Improvement Act of 1982 authorizes PROs to acquire information necessary to fulfill their duties and functions, places limits on the disclosure of PRO information, and establishes penalties for unauthorized disclosure. These regulations would implement the PROs' statutory right of access to necessary information and set forth their responsibilities to assure that information once acquired is adequately safeguarded, and used only for proper purposes.

  15. Can health promotion programs save Medicare money?

    Directory of Open Access Journals (Sweden)

    Ron Z Goetzel

    2007-04-01

    Full Text Available Ron Z Goetzel1, David Shechter2, Ronald J Ozminkowski1, David C Stapleton3, Pauline J Lapin4, J Michael McGinnis5, Catherine R Gordon6, Lester Breslow71Institute for Health and Productivity Studies, Cornell University, Washington, DC; 2Health and Productivity Research, Thomson Medstat, Santa Barbara, CA; 3Cornell Institute for Policy Research, Cornell University, Washington, DC; 4Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, MD; 5National Academy of Sciences, Institute of Medicine, The National Academies, Washington, DC; 6Office of the Director, Centers for Disease Control and Prevention, Washington, DC; 7UCLA School of Public Health, Dept. of Health Services, Los Angeles, CA, USAAbstract: The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program.Keywords: health promotion, return on investment, Medicare, financial

  16. Can health promotion programs save Medicare money?

    Science.gov (United States)

    Goetzel, Ron Z; Shechter, David; Ozminkowski, Ronald J; Stapleton, David C; Lapin, Pauline J; McGinnis, J Michael; Gordon, Catherine R; Breslow, Lester

    2007-01-01

    The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program. PMID:18044084

  17. 76 FR 19527 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-04-07

    ...). Under these provisions, providers of services and suppliers can continue to receive traditional Medicare... Plans and Integration of Community Resources 11. ACO Marketing Guidelines 12. Program Integrity... the Institute of Medicine report: Safety, effectiveness, patient-centeredness, timeliness, efficiency...

  18. Medicare's post-acute care payment: a review of the issues and policy proposals.

    Science.gov (United States)

    Linehan, Kathryn

    2012-12-07

    Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

  19. Medicare Beneficiary Knowledge of the Part D Program

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicare Beneficiary Knowledge of the Part D Program and Its Relationship with Voluntary Enrollment According to findings appearing in Medicare Beneficiary Knowledge...

  20. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ...] Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for Medicare & Medicaid Services... organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to... the Comprehensive Primary Care initiative or the application process. SUPPLEMENTARY INFORMATION: I...

  1. Medicare

    Science.gov (United States)

    ... get about Medicare Lost/incorrect Medicare card Report fraud & abuse File a complaint Identity theft: protect yourself ... the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Sign Up / Change Plans ...

  2. 78 FR 16614 - Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical...

    Science.gov (United States)

    2013-03-18

    ... policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council... issued by the ALJs and the Medicare Appeals Council do not establish Medicare payment policy, we are... Council decisions previously described, this Ruling establishes a policy that revises the current policy...

  3. Evaluation of Medicare Health Support chronic disease pilot program.

    Science.gov (United States)

    Cromwell, Jerry; McCall, Nancy; Burton, Joe

    2008-01-01

    The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

  4. Individualizing Medicare.

    Science.gov (United States)

    Chollet, D J

    1999-05-01

    Despite the enactment of significant changes to the Medicare program in 1997, Medicare's Hospital Insurance trust fund is projected to be exhausted just as the baby boom enters retirement. To address Medicare's financial difficulties, a number of reform proposals have been offered, including several to individualize Medicare financing and benefits. These proposals would attempt to increase Medicare revenues and reduce Medicare expenditures by having individuals bear risk--investment market risk before retirement and insurance market risk after retirement. Many fundamental aspects of these proposals have yet to be worked out, including how to guarantee a baseline level of saving for health insurance after retirement, how retirees might finance unanticipated health insurance price increases after retirement, the potential implications for Medicaid of inadequate individual saving, and whether the administrative cost of making the system fair and adequate ultimately would eliminate any rate-of-return advantages from allowing workers to invest their Medicare contributions in corporate stocks and bonds.

  5. 78 FR 75304 - Medicare Program; Medicare Secondary Payer and Certain Civil Money Penalties

    Science.gov (United States)

    2013-12-11

    ... [CMS-6061-ANPRM] RIN 0938-AR88 Medicare Program; Medicare Secondary Payer and Certain Civil Money... practices for which civil money penalties (CMPs) may or may not be imposed for failure to comply with...-3951. I. Background A. Imposition of Civil Money Penalties (CMPs) In 1981, the Congress added section...

  6. 76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-11-02

    ... Furnished by Non-Physician Practitioners in the Assignment Process c. Assignment of Beneficiaries to ACOs... Insurance Program CMP Civil Monetary Penalties CMS Centers for Medicare & Medicaid Services CNM Certified... the current payment system by rewarding providers for delivering high quality, efficient clinical care...

  7. 77 FR 22071 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

    Science.gov (United States)

    2012-04-12

    ... Outcome Survey HPMS Health Plan Management System ICD-9-CM Internal Classification of Disease, 9th..., Improvement, and Modernization Act of 2003 (Pub. L. 108-173) MS-DRG Medicare Severity Diagnosis Related Group...

  8. Medicare program; clarification of Medicare's accrual basis of accounting policy--HCFA. Final rule.

    Science.gov (United States)

    1995-06-27

    This final rule revises the Medicare regulations to clarify the concept of "accrual basis of accounting" to indicate that expenses must be incurred by a provider of health care services before Medicare will pay its share of those expenses. This rule does not signify a change in policy but, rather, incorporates into the regulations Medicare's longstanding policy regarding the circumstances under which we recognize, for the purposes of program payment, a provider's claim for costs for which it has not actually expended funds during the current cost reporting period.

  9. 76 FR 627 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

    Science.gov (United States)

    2011-01-05

    ... important components of the Medicare ESRD payment system. In the proposed rule, we described the evolution...) of the Social Security Act (the Act), as the next step in the evolution of the ESRD quality program...-mix (for example, nursing home patients, patients with complex conditions) that may make meeting the...

  10. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements. Final rule.

    Science.gov (United States)

    2016-11-15

    This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

  11. 78 FR 72089 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Science.gov (United States)

    2013-12-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6051-N] Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount... period entitled ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening...

  12. Medicare program; Medicare depreciation, useful life guidelines--HCFA. Final rule.

    Science.gov (United States)

    1983-08-18

    These final rules amend Medicare regulations to clarify which useful life guidelines may be used by providers of health care services to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize the Departmental useful life guidelines or, if none have been published by the Department, either the American Hospital Association (AHA) useful life guidelines of 1973 of IRS guidelines. We are eliminating the reference to IRS guidelines because these are now outdated for Medicare purposes since they have been rendered obsolete either by the IRS or by statutory change. We are also deleting the specific reference to the 1973 AHA guidelines since these guidelines are updated by the AHA periodically. In addition, we are clarifying that certain tax legislation on accelerated depreciation, passed by Congress, does not apply to the Medicare program.

  13. 76 FR 48563 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2011...

    Science.gov (United States)

    2011-08-08

    ... Medicare and Medicaid Services Medicare and Medicaid Programs; Quarterly Listing of Program Issuances... Centers for Medicare & Medicaid Services [CMS-9066-NC] Medicare and Medicaid Programs; Quarterly Listing... Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with comment period. SUMMARY: This quarterly notice...

  14. 76 FR 68011 - Medicare Program; Advanced Payment Model

    Science.gov (United States)

    2011-11-02

    ...This notice announces the testing of the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012, and provides information about the model and application process.

  15. Medicare

    Science.gov (United States)

    ... Mariana Islands, Guam, American Samoa, or the U.S. Virgin Islands, we’ll automatically enroll you in Medicare ... enrollment period for people covered under an employer group health plan If you’re 65 or older ...

  16. 75 FR 58405 - Medicare Program; Meeting of the Advisory Panel on Medicare Education, October 13, 2010

    Science.gov (United States)

    2010-09-24

    ... are imposed by section 1804 of the Social Security Act (the Act), requiring the Secretary to provide... President, Social Mission Programs, Independence Blue Cross; Richard C. Frank, M.D., Director, Cancer... Committee Work Summary. Medicare Outreach and Education Strategies. Public Comment. Listening Session with...

  17. 75 FR 3742 - Medicare Program; Meeting of the Advisory Panel on Medicare Education; Cancellation of the...

    Science.gov (United States)

    2010-01-22

    ... the Social Security Act (the Act), requiring the Secretary to provide informational materials to..., National Hispanic Council on Aging; Stephen L. Fera, Vice President, Social Mission Programs, Independence.... Medicare Outreach and Education Strategies. Public Comment. Listening Session with CMS Leadership. Next...

  18. Identifying the Transgender Population in the Medicare Program

    Science.gov (United States)

    Proctor, Kimberly; Haffer, Samuel C.; Ewald, Erin; Hodge, Carla; James, Cara V.

    2016-01-01

    Abstract Purpose: To identify and describe the transgender population in the Medicare program using administrative data. Methods: Using a combination of International Classification of Diseases ninth edition (ICD-9) codes relating to transsexualism and gender identity disorder, we analyzed 100% of the 2013 Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service (FFS) “final action” claims from both institutional and noninstitutional providers (∼1 billion claims) to identify individuals who may be transgender Medicare beneficiaries. To confirm, we developed and applied a multistage validation process. Results: Four thousand ninety-eight transgender beneficiaries were identified, of which ∼90% had confirmatory diagnoses, billing codes, or evidence of a hormone prescription. In general, the racial, ethnic, and geographic distribution of the Medicare transgender population tends to reflect the broader Medicare population. However, age, original entitlement status, and disease burden of the transgender population appear substantially different. Conclusions: Using a variety of claims information, ranging from claims history to additional diagnoses, billing modifiers, and hormone prescriptions, we demonstrate that administrative data provide a valuable resource for identifying a lower bound of the Medicare transgender population. In addition, we provide a baseline description of the diversity and disease burden of the population and a framework for future research. PMID:28861539

  19. The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+Choice Plans

    Science.gov (United States)

    Buntin, Melinda Beeuwkes; Garber, Alan M; McClellan, Mark; Newhouse, Joseph P

    2004-01-01

    Objective To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life—a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source Medicare administrative claims for 1994 and 1995. Study Design We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions More disaggregated prospective

  20. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. Final rule.

    Science.gov (United States)

    2017-11-15

    This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.

  1. 78 FR 25013 - Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment

    Science.gov (United States)

    2013-04-29

    .... ACTION: Proposed rule. SUMMARY: This proposed rule would revise the Incentive Reward Program provisions... significant of these revisions include: changing the Incentive Reward Program potential reward amount for... related to the Incentive Reward Program. Frank Whelan, (410) 786-1302, for issues related to provider...

  2. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... conference will also provide an overview of the Community-based Care Transitions Program (CCTP) and provide...

  3. 78 FR 46339 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria...

    Science.gov (United States)

    2013-07-31

    ...] Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria on... combat fraud, waste, and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment...

  4. 76 FR 15105 - Medicare and Medicaid Programs; Civil Money Penalties for Nursing Homes

    Science.gov (United States)

    2011-03-18

    ... Services 42 CFR Part 488 [CMS-2435-F] Medicare and Medicaid Programs; Civil Money Penalties for Nursing... incentives for quality improvement, and to remove uncertainty for nursing homes, we proposed to set the... Vol. 76 Friday, No. 53 March 18, 2011 Part III Department of Health and Human Services Centers for...

  5. Medicare program; requirements for the Medicare incentive reward program and provider enrollment. Final rule.

    Science.gov (United States)

    2014-12-05

    This final rule implements various provider enrollment requirements. These include: Expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to "backbill" for services performed prior to enrollment.

  6. Medicare program; update of ratesetting methodology, payment rates, payment policies, and the list of covered procedures for ambulatory surgical centers effective October 1, 1998; reopening of comment period and delay in adoption of the proposed rule as final--HCFA. Notice of reopening of comment period for proposed rule and delay in adoption of provisions of the proposed rule as final.

    Science.gov (United States)

    1998-10-01

    This notice reopens the comment period for a proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) that was originally published in the Federal Register on June 12, 1998 (63 FR 32290). This document gives notice of a delay in the adoption of the provisions of the June 12, 1998 ASC proposed rule as a final rule to be concurrent with the adoption as final of the hospital outpatient prospective payment system (PPS) that is the subject of a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47551). In addition this document confirms that the current ASC payment rates that are effective for services furnished on or after October 1, 1998, will remain in effect until rebased ASC rates and the provisions of the June 12, 1998 ASC proposed rule are adopted as final to be concurrent with the adoption as final of the Medicare hospital PPS.

  7. 78 FR 308 - Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health...

    Science.gov (United States)

    2013-01-03

    ... (PQRS), the Children's Health Insurance Program (CHIP), and the Pioneer Accountable Care Organization... No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical...

  8. 76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Science.gov (United States)

    2011-05-09

    ..., and hospices in low-wage index areas are unfairly advantaged. The commenter felt that our not wage... Medicare & Medicaid Services 42 CFR Part 418 Medicare Program; Hospice Wage Index for Fiscal Year 2012... [CMS-1355-P] RIN 0938-AQ31 Medicare Program; Hospice Wage Index for Fiscal Year 2012 AGENCY: Centers...

  9. 42 CFR 460.168 - Reinstatement in other Medicare and Medicaid programs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Reinstatement in other Medicare and Medicaid programs. 460.168 Section 460.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Reinstatement in other Medicare and Medicaid programs. To facilitate a participant's reinstatement in other...

  10. 78 FR 45231 - Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality...

    Science.gov (United States)

    2013-07-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3280-FN] Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality's (CIHQ's) Hospital Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION: Final...

  11. CMS Medicare and Medicaid EHR Incentive Program, Electronic Health Record Products Used for Attestation

    Data.gov (United States)

    U.S. Department of Health & Human Services — Data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the...

  12. 75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2010-11-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN] Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery... Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national...

  13. 75 FR 44313 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program

    Science.gov (United States)

    2010-07-28

    ... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...), eligible hospitals and critical access hospitals (CAHs) participating in Medicare and Medicaid programs...) technology. This final rule specifies--the initial criteria EPs, eligible hospitals, and CAHs must meet in...

  14. 75 FR 1843 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program

    Science.gov (United States)

    2010-01-13

    ... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...) and eligible hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use... an EP and eligible hospital must meet in order to qualify for the incentive payment; calculation of...

  15. 76 FR 78926 - Medicare and Medicaid Programs; Announcement of Application From Hospital Requesting Waiver for...

    Science.gov (United States)

    2011-12-20

    ... comment period. SUMMARY: This notice with comment period announces a waiver request from Pioneer Community... which the hospital is located: Pioneer Community Hospital (Medicare provider number 25-1302), of... No. 93.773, Medicare--Hospital Insurance; Program No. 93.774, Medicare-- Supplementary Medical...

  16. 75 FR 5599 - Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for...

    Science.gov (United States)

    2010-02-03

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1341-NC] Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

  17. 78 FR 98 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

    Science.gov (United States)

    2013-01-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1456-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

  18. 77 FR 51539 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

    Science.gov (United States)

    2012-08-24

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1452-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

  19. 78 FR 19269 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

    Science.gov (United States)

    2013-03-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1457-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...

  20. 77 FR 9931 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2011

    Science.gov (United States)

    2012-02-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9069-N] Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--October Through December 2011 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This quarterly...

  1. 76 FR 24213 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2011-04-29

    ... 2012 IRF PPS Federal Prospective Payment Rates A. Proposed Market Basket Increase Factor, Productivity.... Proposed Productivity Adjustment 3. Proposed Calculation of the IRF PPS Market Basket Increase Factor for... Medicare Provider Analysis and Review MFP Multifactor Productivity MMSEA Medicare, Medicaid, and SCHIP...

  2. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Science.gov (United States)

    2010-06-08

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare...

  3. Measuring Coding Intensity in the Medicare Advantage Program

    Data.gov (United States)

    U.S. Department of Health & Human Services — In 2004, Medicare implemented a risk-adjustment system that pays Medicare Advantage (MA) plans based on diagnoses reported for their enrollees, giving the plans an...

  4. 76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction

    Science.gov (United States)

    2011-07-05

    ... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...

  5. 76 FR 54599 - Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs

    Science.gov (United States)

    2011-09-01

    ...), prescription drug benefit program (Part D) and section 1876 cost plans including conforming changes to the MA... accounts (MSA) plans, cost-sharing for dual-eligible enrollees in the MA program and prescription drug pricing, coverage, and payment processes in the Part D program, and requirements governing the marketing...

  6. 75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-27

    ... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...

  7. 75 FR 76293 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-08

    ... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...

  8. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-17

    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

  9. 76 FR 59265 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

    Science.gov (United States)

    2011-09-26

    ... [CMS-1351-CN] RIN 0938-AQ29 Medicare Program; Prospective Payment System and Consolidated Billing for... rule entitled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled... Payment System (PPS) final rule (76 FR 48486, 48540) inadvertently included several technical errors in...

  10. Results of the Medicare Health Support disease-management pilot program.

    Science.gov (United States)

    McCall, Nancy; Cromwell, Jerry

    2011-11-03

    In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

  11. 75 FR 71189 - Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug...

    Science.gov (United States)

    2010-11-22

    ... changes to the regulations to reflect provisions in the ACA which either are already in effect, or have an... Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) (ACA) and make... Necessity Decisions by a Physician or Other Health Care Professional and the Employment of a Medical...

  12. Medicare and Medicaid programs; advance directives--HCFA. Final rule.

    Science.gov (United States)

    1995-06-27

    This final rule responds to public comments on the March 6, 1992 interim final rule with comment period that amended the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and managed care plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of the advance directives provisions is to enhance an adult individual's control over medical treatment decisions. This rule confirms the interim final rule with several minor changes based on our review and consideration of public comments.

  13. 77 FR 1877 - Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Negotiated Pricing...

    Science.gov (United States)

    2012-01-12

    ... proposed to include definitions of ``actually paid,'' ``administrative costs,'' ``allowable retiree costs... theories under which we might have such authority. Also in the January 12, 2009 Federal Register, we..., and our final rule with comment period set forth three theories under which we might have such...

  14. 77 FR 11130 - Medicare Program; Application by the American Association of Diabetes Educators (AADE) for...

    Science.gov (United States)

    2012-02-24

    ...] Medicare Program; Application by the American Association of Diabetes Educators (AADE) for Continued... American Association of Diabetes Educators' (AADE) request for the Secretary's approval of its... Association of Diabetes Educators for continued recognition as a national accreditation program for...

  15. 78 FR 53149 - Medicare and Medicaid Programs: Continued Approval of American Osteopathic Association/Healthcare...

    Science.gov (United States)

    2013-08-28

    ... the requirements at Sec. 482.41(c)(4), AOA/HFAP revised its standards to include the National Fire... Insurance Program; and No. 93.774, Medicare--Supplementary Medical Insurance Program) Dated: July 19, 2013...

  16. 76 FR 59138 - Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for...

    Science.gov (United States)

    2011-09-23

    ... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... $1,350 for judicial review. DATES: Effective Date: This notice is effective on January 1, 2012. FOR...

  17. 75 FR 58407 - Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for...

    Science.gov (United States)

    2010-09-24

    ... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... judicial review. DATES: Effective Date: This notice is effective on January 1, 2011. FOR FURTHER...

  18. 78 FR 59702 - Medicare Program; Medicare Appeals: Adjustment to the Amount in Controversy Threshold Amounts for...

    Science.gov (United States)

    2013-09-27

    ... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... ALJ hearings and $1,430 for judicial review. DATES: This notice is effective on January 1, 2014. FOR...

  19. 77 FR 59618 - Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for...

    Science.gov (United States)

    2012-09-28

    ... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... $1,400 for judicial review. Effective Date: This notice is effective on January 1, 2013. FOR FURTHER...

  20. 76 FR 28196 - Medicare and Medicaid Programs; Opportunities for Alignment Under Medicaid and Medicare

    Science.gov (United States)

    2011-05-16

    ... partner with States, providers, beneficiaries and their caregivers, and other stakeholders to improve... conflicting Medicaid and Medicare requirements. This document represents the first step. We have compiled what.... We will then determine which issues to address and in what order and timeframe. All areas are...

  1. 77 FR 38067 - Medicare Program; Public Meeting Regarding Inherent Reasonableness of Medicare Fee Schedule...

    Science.gov (United States)

    2012-06-26

    ... forth in 42 CFR 414.402 will be used to determine what items will be included in the competitions. These..., regardless of the method of delivery. Non-Mail Order Item--Any item that a beneficiary or caregiver picks up... what Medicare pays for mail order supplies versus non-mail order supplies may encourage fraud and abuse...

  2. 75 FR 52629 - Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prosthetics...

    Science.gov (United States)

    2010-08-27

    ... outpatient rehabilitation facility (CORF), a home health agency (HHA), or a hospice that has in effect an agreement to participate in Medicare, or a clinic, a rehabilitation agency, or a public health agency that... devices used for reduction of fractures and dislocation'' as one of the ``medical and other health...

  3. 77 FR 69850 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

    Science.gov (United States)

    2012-11-21

    ... of the Actuary in the Centers for Medicare & Medicaid Services. The estimates underlying these determinations are prepared by actuaries meeting the qualification standards and following the actuarial... alternative analysis and financial projection purposes, and the Office of the Actuary has adopted this...

  4. 75 FR 52760 - Medicare Program; Listening Session Regarding the Implementation of Section 10332 of the Patient...

    Science.gov (United States)

    2010-08-27

    ...] Medicare Program; Listening Session Regarding the Implementation of Section 10332 of the Patient Protection... of the Patient Protection and Affordable Care Act (the Affordable Care Act), which amended section 1874 of the Social Security Act: Availability of Medicare Data for Performance Measurement. The purpose...

  5. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...

  6. 76 FR 32085 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

    Science.gov (United States)

    2011-06-03

    ..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...

  7. 76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2011-02-18

    ... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...

  8. 77 FR 29001 - Medicare and Medicaid Program; Regulatory Provisions to Promote Program Efficiency, Transparency...

    Science.gov (United States)

    2012-05-16

    ... Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Final Rule #0;#0;Federal..., Transparency, and Burden Reduction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final... on providers of care. CMS has also identified non-regulatory changes to increase transparency and to...

  9. Medicare program; appeals of CMS or CMS contractor determinations when a provider or supplier fails to meet the requirements for Medicare billing privileges. Final rule.

    Science.gov (United States)

    2008-06-27

    This final rule implements a number of regulatory provisions that are applicable to all providers and suppliers, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. This final rule establishes appeals processes for all providers and suppliers whose enrollment, reenrollment or revalidation application for Medicare billing privileges is denied and whose Medicare billing privileges are revoked. It also establishes timeframes for deciding enrollment appeals by an Administrative Law Judge (ALJ) within the Department of Health and Human Services (DHHS) or the Departmental Appeals Board (DAB), or Board, within the DHHS; and processing timeframes for CMS' Medicare fee-for-service (FFS) contractors. In addition, this final rule allows Medicare FFS contractors to revoke Medicare billing privileges when a provider or supplier submits a claim or claims for services that could not have been furnished to a beneficiary. This final rule also specifies that a Medicare contractor may establish a Medicare enrollment bar for any provider or supplier whose billing privileges have been revoked. Lastly, the final rule requires that all providers and suppliers receive Medicare payments by electronic funds transfer (EFT) if the provider or supplier, is submitting an initial enrollment application to Medicare, changing their enrollment information, revalidating or re-enrolling in the Medicare program.

  10. 78 FR 57857 - Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of...

    Science.gov (United States)

    2013-09-20

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3287-PN] Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of its Rural Health Clinic Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION...

  11. 78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

    Science.gov (United States)

    2013-07-09

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431 [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

  12. 42 CFR 421.304 - Medicare integrity program contractor functions.

    Science.gov (United States)

    2010-10-01

    ... services for which Medicare payment may be made either directly or indirectly. (b) Auditing, settling and... and benefit quality assurance issues. (e) Developing, and periodically updating, a list of items of...

  13. 76 FR 50224 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-08-12

    ...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... (CMS). This two-day training session is the second Accelerated Development Learning Session (ADLS.... Through Accelerated Development Learning Sessions (ADLS), the Innovation Center will test whether...

  14. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-10-28

    ...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... Services (CMS). This two-day training session is the third and final Accelerated Development Learning... the quality of care for beneficiaries. Through Accelerated Development Learning Sessions (ADLS), the...

  15. 75 FR 24437 - Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and...

    Science.gov (United States)

    2010-05-05

    ... including Directors and Board Members of corporations and non-profit organizations and charities. The..., ``Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to...

  16. Public financing of the Medicare program will make its uniform structure increasingly costly to sustain.

    Science.gov (United States)

    Baicker, Katherine; Shepard, Mark; Skinner, Jonathan

    2013-05-01

    The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.

  17. 77 FR 38066 - Medicare Program; Announcement of a New Opportunity for Participation in the Advance Payment...

    Science.gov (United States)

    2012-06-26

    ...This notice announces a new opportunity for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in January 2013.

  18. 76 FR 74067 - Medicare Program; Announcement of a New Application Deadline for the Advance Payment Model

    Science.gov (United States)

    2011-11-30

    ...This notice announces a new application deadline for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012.

  19. 75 FR 70013 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2010-11-16

    ... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...

  20. Changes in Postacute Care in the Medicare Shared Savings Program.

    Science.gov (United States)

    McWilliams, J Michael; Gilstrap, Lauren G; Stevenson, David G; Chernew, Michael E; Huskamp, Haiden A; Grabowski, David C

    2017-04-01

    Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Patient attribution to an ACO in the MSSP. Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control group, -$106 per beneficiary [95% CI, -$176 to -$35], or -9.0% of the precontract unadjusted mean of $1172; P = .003) that was driven by differential reductions in acute inpatient care, discharges to facilities rather than home (-0.6 percentage points [95% CI, -1.1 to 0.0], or -2.7% of the unadjusted precontract mean of 22.6%; P = .03), and length of SNF stays (-0.60 days per stay [95% CI, -0.99 to -0.22], or -2.2% of the precontract unadjusted mean of 27.07 days; P = .002). Reductions in use of SNFs and length of stay were largely due to within-hospital or

  1. Measuring coding intensity in the Medicare Advantage program.

    Science.gov (United States)

    Kronick, Richard; Welch, W Pete

    2014-01-01

    In 2004, Medicare implemented a system of paying Medicare Advantage (MA) plans that gave them greater incentive than fee-for-service (FFS) providers to report diagnoses. Risk scores for all Medicare beneficiaries 2004-2013 and Medicare Current Beneficiary Survey (MCBS) data, 2006-2011. Change in average risk score for all enrollees and for stayers (beneficiaries who were in either FFS or MA for two consecutive years). Prevalence rates by Hierarchical Condition Category (HCC). Each year the average MA risk score increased faster than the average FFS score. Using the risk adjustment model in place in 2004, the average MA score as a ratio of the average FFS score would have increased from 90% in 2004 to 109% in 2013. Using the model partially implemented in 2014, the ratio would have increased from 88% to 102%. The increase in relative MA scores appears to largely reflect changes in diagnostic coding, not real increases in the morbidity of MA enrollees. In survey-based data for 2006-2011, the MA-FFS ratio of risk scores remained roughly constant at 96%. Intensity of coding varies widely by contract, with some contracts coding very similarly to FFS and others coding much more intensely than the MA average. Underpinning this relative growth in scores is particularly rapid relative growth in a subset of HCCs. Medicare has taken significant steps to mitigate the effects of coding intensity in MA, including implementing a 3.4% coding intensity adjustment in 2010 and revising the risk adjustment model in 2013 and 2014. Given the continuous relative increase in the average MA risk score, further policy changes will likely be necessary.

  2. 76 FR 41260 - Supplemental Funding for the Senior Medicare Patrol (SMP) Program

    Science.gov (United States)

    2011-07-13

    ... additional funding to double the size of the SMP program. The SMP program expansion has resulted in... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Supplemental Funding for the Senior Medicare Patrol (SMP) Program ACTION: Notice of intent to provide supplemental funding to the...

  3. 76 FR 78741 - Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of...

    Science.gov (United States)

    2011-12-19

    ... Parts 402 and 403 [CMS-5060-P] RIN 0938-AR33 Medicare, Medicaid, Children's Health Insurance Programs...'s Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers... State plan under title XIX (Medicaid) or XXI of the Act (the Children's Health Insurance Program, or...

  4. 76 FR 11782 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal, Expansion, and Renaming of...

    Science.gov (United States)

    2011-03-03

    ...] Medicare, Medicaid, and Children's Health Insurance Programs; Renewal, Expansion, and Renaming of the...'s Health Insurance Program (CHIP) about options for selecting health care coverage under these and... needs are for experts in health disparities, State Health Insurance Assistance Programs (SHIPs), health...

  5. Catching flies with vinegar: a critique of the Centers for Medicare and Medicaid self-disclosure program.

    Science.gov (United States)

    Veilleux, Jean Wright

    2012-01-01

    This Article argues that the current approach of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to enforcement of the Ethics in Patient Referrals Act (the "Stark Law") is unnecessarily punitive and discourages health-care providers from self-disclosing even very minor violations of the Stark Law. This Article suggests a number of specific changes to encourage provider self-disclosure and proposes that CMS create a demonstration project under the authority of the Patient Protection and Affordable Care Act to test the reforms. A demonstration project provides the perfect vehicle to prove that increased self-disclosure protocols for the Stark Law can decrease the government's costs of enforcement, improve program integrity, and encourage providers to deal responsibly with the inevitable minor lapses in compliance that arise in such an enormous government program as Medicare.

  6. Lessons for the new CMS innovation center from the Medicare health support program.

    Science.gov (United States)

    Barr, Michael S; Foote, Sandra M; Krakauer, Randall; Mattingly, Patrick H

    2010-07-01

    The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

  7. MACRA, MIPS, and the New Medicare Quality Payment Program: An Update for Radiologists.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Nicola, Gregory N; Allen, Bibb; Hughes, Danny R; Hirsch, Joshua A

    2017-03-01

    The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 advances the goal of tying Medicare payments to quality and value. In April 2016, CMS published an initial proposed rule for MACRA, renaming it the Quality Payment Program (QPP). Under QPP, clinicians receive payments through either advanced alternative payment models or the Merit-Based Incentive Payment System (MIPS), a consolidation of existing federal performance programs that applies positive or negative adjustments to fee-for-service payments. Most physicians will participate in MIPS. This review highlights implications of the QPP and MIPS for radiologists. Although MIPS incorporates radiology-specific quality measures, radiologists will also be required to participate in other practice improvement activities, including patient engagement. Recognizing physicians' unique practice patterns, MIPS will provide special considerations in performance evaluation for physicians with limited face-to-face patient interaction. Although such considerations will affect radiologists' likelihood of success under QPP, many practitioners will be ineligible for the considerations under currently proposed criteria. Reporting using qualified clinical data registries will benefit radiologists' performance by allowing expanded arrays of MIPS and non-MIPS specialty-specific measures. A group practice reporting option will substantially reduce administrative burden but introduce new challenges by requiring uniform determination of patient-facing status and performance measurement for all of the group's physicians (diagnostic radiologists, interventional radiologists, and nonradiologists) under the same taxpayer identification number. Given that the initial MIPS performance period begins in 2017, radiologists must begin preparing for QPP and taking actions to ensure their future success under this new quality-based payment system. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights

  8. 75 FR 73090 - Medicare Program; Listening Session on Development of Additional Imaging Efficiency Measures for...

    Science.gov (United States)

    2010-11-29

    ...] Medicare Program; Listening Session on Development of Additional Imaging Efficiency Measures for Use in the...), HHS. ACTION: Notice of meeting. SUMMARY: This notice announces a listening session to receive comments... Quality Data Reporting Program (HOP QDRP), which is authorized under section 1833(t)(17) of the Social...

  9. 78 FR 21610 - Expansion Funds for the Support of the Senior Medicare Patrol (SMP) Program

    Science.gov (United States)

    2013-04-11

    ... Grants. Announcement Type: Health Care Fraud Prevention Program Expansion Capacity. Funding Opportunity... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living Expansion Funds for the Support of the Senior Medicare Patrol (SMP) Program ACTION: Notice of intent to provide expansion...

  10. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ... stakeholders to develop initiatives to test innovative payment and service delivery models to reduce program...] Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission Deadlines for... of the Pioneer Accountable Care Organization Model letters of intent to June 30, 2011 and the...

  11. 78 FR 9457 - Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of...

    Science.gov (United States)

    2013-02-08

    ... Parts 402 and 403 [CMS-5060-F] RIN 0938-AR33 Medicare, Medicaid, Children's Health Insurance Programs...'s Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers... Vol. 78 Friday, No. 27 February 8, 2013 Part II Department of Health and Human Services Centers...

  12. Effects of a Community-Based Fall Management Program on Medicare Cost Savings.

    Science.gov (United States)

    Ghimire, Ekta; Colligan, Erin M; Howell, Benjamin; Perlroth, Daniella; Marrufo, Grecia; Rusev, Emil; Packard, Michael

    2015-12-01

    Fall-related injuries and health risks associated with reduced mobility or physical inactivity account for significant costs to the U.S. healthcare system. The widely disseminated lay-led A Matter of Balance (MOB) program aims to help older adults reduce their risk of falling and associated activity limitations. This study examined effects of MOB participation on health service utilization and costs for Medicare beneficiaries, as a part of a larger effort to understand the value of community-based prevention and wellness programs for Medicare. A controlled retrospective cohort study was conducted in 2012-2013, using 2007-2011 MOB program data and 2006-2013 Medicare data. It investigated program effects on falls and fall-related fractures, and health service utilization and costs (standardized to 2012 dollars), of 6,136 Medicare beneficiaries enrolled in MOB from 2007 through 2011. A difference-in-differences analysis was employed to compare outcomes of MOB participants with matched controls. MOB participation was associated with total medical cost savings of $938 per person (95% CI=$379, $1,498) at 1 year. Savings per person amounted to $517 (95% CI=$265, $769) for unplanned hospitalizations; $81 for home health care (95% CI=$20, $141); and $234 (95% CI=$55, $413) for skilled nursing facility care. Changes in the incidence of falls or fall-related fractures were not detected, suggesting that cost savings accrue through other mechanisms. This study suggests that MOB and similar prevention programs have the potential to reduce Medicare costs. Further research accounting for program delivery costs would help inform the development of Medicare-covered preventive benefits. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

  13. 78 FR 78802 - Medicare Program; Right of Appeal for Medicare Secondary Payer Determination Relating to...

    Science.gov (United States)

    2013-12-27

    ... ``More Search Options'' tab. 2. By regular mail. You may mail written comments to the following address... million or more in any 1 year). We have determined that the effect of this proposed rule on the economy...

  14. Society for Health Psychology (APA Division 38) and Society of Behavioral Medicine joint position statement on the Medicare Diabetes Prevention Program.

    Science.gov (United States)

    Fitzpatrick, Stephanie L; Wilson, Dawn K; Pagoto, Sherry L

    2017-06-01

    Beginning in January 2018, the Centers for Medicare and Medicaid Services (CMS) plans to cover the Diabetes Prevention Program (DPP), also referred to as Medicare DPP. The American Psychological Association Society for Health Psychology (SfHP) and the Society for Behavioral Medicine (SBM) reviewed the proposed plan. SfHP and SBM are in support of the CMS decision to cover DPP for Medicare beneficiaries but have a significant concern that aspects of the proposal will limit the public health impact. Concerns include the emphasis on weight outcomes to determine continued coverage and the lack of details regarding requirements for coaches. SfHP and SBM are in strong support of modifications to the proposal that would remove the minimum weight loss stipulation to determine coverage and to specify type and qualifications of "coaches."

  15. 77 FR 55479 - Medicare, Medicaid, and CHIP Programs: Research and Analysis on Impact of CMS Programs on the...

    Science.gov (United States)

    2012-09-10

    ..., Medicaid, and CHIP Programs: Research and Analysis on Impact of CMS Programs on the Indian Health Care System AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice of Single Source Award. SUMMARY: This notice supports expansion of research on the impact of CMS programs on the Indian health...

  16. 75 FR 30041 - Medicare Program; Public Meeting in Calendar Year 2010 for New Clinical Laboratory Tests Payment...

    Science.gov (United States)

    2010-05-28

    ... specified list of new Clinical Procedural Terminology (CPT) codes for clinical laboratory tests in calendar... are codified at 42 CFR part 414, subpart G. A newly created Current Procedural Terminology (CPT) code..., Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program...

  17. 75 FR 30043 - Medicare Program; Meeting of the Advisory Panel on Medicare Education

    Science.gov (United States)

    2010-05-28

    ... imposed * * * by law.'' Such duties are imposed by section 1804 of the Social Security Act (the Act...; Stephen P. Fera, M.B.A., Vice President, Social Mission Programs, Independence Blue Cross; Nan-Kirsten... Education Strategies. Public Comment. Listening Session with CMS Leadership. Next Steps. Individuals or...

  18. 78 FR 79081 - Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid...

    Science.gov (United States)

    2013-12-27

    ... Conditions for Coverage CHAP Community Health Accreditation Program CMHC Community Mental Health Center COI... Pathology Services (Sec. 485.727) N. Emergency Preparedness Regulations for Community Mental Health Centers... Preparedness for Community Mental Health Centers (CMHCs)--Training and Testing (Sec. 485.920(d)) R. Conditions...

  19. Medicare program; offset of Medicare payments to individuals to collect past-due obligations arising from breach of scholarship and loan contracts--HCFA. Final rule.

    Science.gov (United States)

    1992-05-04

    This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.

  20. The Medicare Health Outcomes Survey program: Overview, context, and near-term prospects

    Directory of Open Access Journals (Sweden)

    Miller Nancy A

    2004-07-01

    Full Text Available Abstract In 1996, the Centers for Medicare & Medicaid Services (CMS initiated the development of the Medicare Health Outcomes Survey (HOS. It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1 a recognized need to monitor the performance of managed care plans, 2 technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3 the existence of a tested functional health status assessment tool (SF-36®1, which was valid for an elderly population, 4 CMS leadership, and 5 political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1 Supports the technical/scientific development of the HOS measure, 2 Certifies survey vendors, 3 Collects Health Plan Employer Data and Information Set(HEDIS®2 HOS data, 4 Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs, Medicare+Choice Organizations (M+COs, and other stakeholders, 5 Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6 Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7 Conducts analyses using HOS data to support CMS and HHS priorities. CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the

  1. 76 FR 35683 - Medicare Program; Conditions of Participation (CoPs) for Community Mental Health Centers

    Science.gov (United States)

    2011-06-17

    ... Community Mental Health Centers; Proposed Rule #0;#0;Federal Register / Vol. 76 , No. 117 / Friday June 17... (CoPs) for Community Mental Health Centers AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... participation (CoPs) that community mental health centers (CMHCs) would have to meet in order to participate in...

  2. 75 FR 39641 - Medicare and Medicaid Programs; Civil Money Penalties for Nursing Homes

    Science.gov (United States)

    2010-07-12

    ... law judge (ALJ) reverses the civil money penalty determination in whole or in part, the escrowed..., widespread harm, or resulting in a resident's death is not eligible for the civil money penalty reduction... Penalties for Nursing Homes AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed...

  3. 75 FR 80762 - Medicare Program; Emergency Medical Treatment and Labor Act: Applicability to Hospital and...

    Science.gov (United States)

    2010-12-23

    ... [CMS-1350-ANPRM] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act... Emergency Medical Treatment and Labor Act (EMTALA). Specifically, this document serves as a request for... available to persons without Federal government identification, commenters are encouraged to leave their...

  4. 77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital...

    Science.gov (United States)

    2012-02-02

    ... [CMS-1350-NC] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA... the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients... available to persons without Federal government identification, commenters are encouraged to leave their...

  5. 77 FR 44255 - Medicare Program; Application by the American Association of Diabetes Educators (AADE) for...

    Science.gov (United States)

    2012-07-27

    ...] Medicare Program; Application by the American Association of Diabetes Educators (AADE) for Continued... Register (77 FR 11130) entitled, ``Application by the American Association of Diabetes Educators (AADE) for... Notice. SUMMARY: This final notice announces the approval of an application from the American Association...

  6. 77 FR 17070 - Medicare and Medicaid Programs; Application From Det Norske Veritas Healthcare (DNVHC) for...

    Science.gov (United States)

    2012-03-23

    ... for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the... accrediting body's approved program would be deemed to have met the Medicare conditions. A national... the national accrediting body making the request, describing the nature of the request, and providing...

  7. 78 FR 59701 - Medicare Program; Approval of Accrediting Organization for Suppliers of Advanced Diagnostic...

    Science.gov (United States)

    2013-09-27

    ...] Medicare Program; Approval of Accrediting Organization for Suppliers of Advanced Diagnostic Imaging... accredit suppliers seeking to furnish the technical component (TC) of advanced diagnostic imaging services... advanced diagnostic imaging (ADI) service and establish procedures to ensure that the criteria used by an...

  8. 75 FR 46948 - Medicare Program; Listening Session Regarding Confidential Feedback Reports and the...

    Science.gov (United States)

    2010-08-04

    ...] Medicare Program; Listening Session Regarding Confidential Feedback Reports and the Implementation of a... Services (CMS), HHS. ACTION: Notice of meeting. SUMMARY: This notice announces a listening session being... modifier to the fee- for-service physician fee schedule. The purpose of the listening session is to solicit...

  9. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Science.gov (United States)

    2011-05-20

    ... Affordable Care Act, to test innovative payment and service delivery models that reduce spending under.... This Model will test the effectiveness of a combination of the following: Payment arrangements that...] Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications AGENCY: Centers for...

  10. 75 FR 45699 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010...

    Science.gov (United States)

    2010-08-03

    ... Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System...-1414-CN2] RIN 0938-AP41 Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010...

  11. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-10-01

    ...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

  12. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-02-01

    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

  13. 76 FR 59256 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2011-09-26

    ...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...

  14. 76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

    Science.gov (United States)

    2011-03-11

    ... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for...

  15. 77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-29

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

  16. 76 FR 68525 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012

    Science.gov (United States)

    2011-11-04

    ... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...

  17. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Science.gov (United States)

    2010-06-17

    ... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

  18. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-03-13

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

  19. 76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage

    Science.gov (United States)

    2011-10-24

    ... consequence of increasing health care costs to the Medicare program and limiting the choices of those patients... with information concerning the illness, injury or condition that brought the patient to the ASC, as.../grievances relating, but not limited to, mistreatment, neglect, verbal, mental, sexual, or physical abuse...

  20. 78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

    Science.gov (United States)

    2013-05-31

    ...] Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for Available... announces the closure of two teaching hospitals and the initiation of an application process where hospitals... modifying language at section 1886(d)(5)(B)(v) of the Act, to instruct the Secretary to establish a process...

  1. 76 FR 66929 - Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2011-10-28

    ...] Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery Facilities... receipt of a deeming application from the American Association for Accreditation of Ambulatory Surgery... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice also...

  2. Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries.

    Science.gov (United States)

    Zeng, Wu; Stason, William B; Fournier, Stephen; Razavi, Moaven; Ritter, Grant; Strickler, Gail K; Bhalotra, Sarita M; Shepard, Donald S

    2013-05-01

    This study reports outcomes of a Medicare-sponsored demonstration of two intensive lifestyle modification programs (LMPs) in patients with symptomatic coronary heart disease: the Cardiac Wellness Program of the Benson-Henry Mind Body Institute (MBMI) and the Dr Dean Ornish Program for Reversing Heart Disease® (Ornish). This multisite demonstration, conducted between 2000 and 2008, enrolled Medicare beneficiaries who had had an acute myocardial infarction or a cardiac procedure within the preceding 12 months or had stable angina pectoris. Health and economic outcomes are compared with matched controls who had received either traditional or no cardiac rehabilitation following similar cardiac events. Each program included a 1-year active intervention of exercise, diet, small-group support, and stress reduction. Medicare claims were used to examine 3-year outcomes. The analysis includes 461 elderly, fee-for-service, Medicare participants and 1,795 controls. Cardiac and non-cardiac hospitalization rates were lower in participants than controls in each program and were statistically significant in MBMI (P costs of $3,801 and $4,441 per participant for the MBMI and Ornish Programs, respectively, were offset by reduced health care costs yielding non-significant three-year net savings per participant of about $3,500 in MBMI and $1,000 in Ornish. A trend towards lower mortality compared with controls was observed in MBMI participants (P = .07). Intensive, year-long LMPs reduced hospitalization rates and suggest reduced Medicare costs in elderly beneficiaries with symptomatic coronary heart disease. Copyright © 2013 Mosby, Inc. All rights reserved.

  3. Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008

    Directory of Open Access Journals (Sweden)

    Menz Hylton B

    2009-10-01

    Full Text Available Abstract Background In 2004, as an extension of the Enhanced Primary Care (EPC program, the Australian Government introduced a policy of providing Medicare rebates for allied health services provided to patients with chronic or complex health conditions. The objective of this study was to evaluate the utilisation of podiatry services provided under this scheme between 2004 and 2008. Methods Data pertaining to the Medicare item 10962 for the calendar years 2004-2008 were extracted from the Australian Medicare Benefits Schedule (MBS database and cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number of consultations provided and to assess for temporal trends over the five-year assessment period. The total cost to Medicare over this period was also determined. Results During the 2004-2008 period, a total of 1,338,044 EPC consultations were provided by podiatrists in Australia. Females exhibited higher utilisation than males (63 versus 37%, and those aged over 65 years accounted for 75% of consultations. There was a marked increase in the number of consultations provided from 2004 to 2008, and the total cost of providing EPC podiatry services during this period was $62.9 M. Conclusion Podiatry services have been extensively utilised under the EPC program by primary care patients, particularly older women, and the number of services provided has increased dramatically between 2004 and 2008. Further research is required to determine whether the EPC program enhances clinical outcomes compared to standard practice.

  4. Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008.

    Science.gov (United States)

    Menz, Hylton B

    2009-10-30

    In 2004, as an extension of the Enhanced Primary Care (EPC) program, the Australian Government introduced a policy of providing Medicare rebates for allied health services provided to patients with chronic or complex health conditions. The objective of this study was to evaluate the utilisation of podiatry services provided under this scheme between 2004 and 2008. Data pertaining to the Medicare item 10962 for the calendar years 2004-2008 were extracted from the Australian Medicare Benefits Schedule (MBS) database and cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number of consultations provided and to assess for temporal trends over the five-year assessment period. The total cost to Medicare over this period was also determined. During the 2004-2008 period, a total of 1,338,044 EPC consultations were provided by podiatrists in Australia. Females exhibited higher utilisation than males (63 versus 37%), and those aged over 65 years accounted for 75% of consultations. There was a marked increase in the number of consultations provided from 2004 to 2008, and the total cost of providing EPC podiatry services during this period was $62.9 M. Podiatry services have been extensively utilised under the EPC program by primary care patients, particularly older women, and the number of services provided has increased dramatically between 2004 and 2008. Further research is required to determine whether the EPC program enhances clinical outcomes compared to standard practice.

  5. Sugar daddy. Most Americans know Medicare as the health insurance program for the elderly, but to providers, it's a jobs program, a capital financier and a safety net.

    Science.gov (United States)

    Hallam, K; Gardner, J

    1999-11-08

    Most Americans know Medicare as the health insurance program that covers the elderly. But to providers it's much more that. The program pays for medical education, finances capital projects and subsidizes care for the indigent. Should Medicare continue making those add-on payments? Is that the program's mission? The debate is intensifying.

  6. 75 FR 78246 - Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC...

    Science.gov (United States)

    2010-12-15

    ...] Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups... announces the re-chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the... (APC) groups and their associated weights established under the Medicare hospital Outpatient...

  7. Plenary III–04: Responses to Drug Costs: Year Three of the Medicare Part D Program

    OpenAIRE

    Fung, Vicki; Reed, Mary; Hsu, John

    2010-01-01

    Background/Aims: Many Medicare Part D beneficiaries face substantial prescription drug cost-sharing. In the first year of the program, many beneficiaries reported substantial drug use changes in response to the coverage gap. In response, an increasing number of plans offer generic drug coverage during the gap. We compared responses to Part D costs among beneficiaries with generic-only gap coverage and full gap coverage in 2008, the third year of the Part D program.

  8. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

    Science.gov (United States)

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-06-01

    To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

  9. Medicare: Comparison of Catastrophic Health Insurance Proposals--An Update. Briefing Report to the Chairman, Select Committee on Aging, House of Representatives.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This document updates a recent report by the General Accounting Office (GAO) which compared Medicare catastrophic health insurance proposals. The update includes H.R. 2470, as passed by the House of Representatives and S. 1127, as reported by the Senate Committee on Finance. An introduction explains the roles of Medicare, Medicaid, the Veterans…

  10. Medicare 1144 Outreach

    Data.gov (United States)

    Social Security Administration — The purpose of this exchange is to identify any Medicare beneficiary who may be eligible for Medicare cost sharing under the Medicaid program, notify these potential...

  11. 78 FR 14689 - Medicare Program; Extension of the Payment Adjustment for Low-volume Hospitals and the Medicare...

    Science.gov (United States)

    2013-03-07

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 412... philosophy and principles identified in Executive Order 12866 and 13563, the RFA, and section 1102(b) of the.... Approved: March 1, 2013. Kathleen Sebelius, Secretary, Department of Health and Human Services. [FR Doc...

  12. Medicare Home Health Services: A Difficult Program to Control

    Science.gov (United States)

    1981-09-25

    represent about one-third of all visits provided under the program. Family and friends altio provide similar services to the elderly and consequently...example, that the individual is to be confined to his or her home but that this does not necessarily mean that the patient is bedridden . At the same...34feebleness" and "insecurity" cannot be considered home- bound. We believe that in many cases (particularly for the elderly ) it would be extremely

  13. 76 FR 65909 - Medicare and Medicaid Program; Regulatory Provisions To Promote Program Efficiency, Transparency...

    Science.gov (United States)

    2011-10-24

    ... Efficiency, Transparency, and Burden Reduction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS...-regulatory changes to increase transparency and to become a better business partner. As explained in the plan...

  14. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    Science.gov (United States)

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  15. Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.

    Science.gov (United States)

    Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B

    2015-06-01

    To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

  16. 77 FR 69859 - Medicare Program; Part A Premiums for CY 2013 for the Uninsured Aged and for Certain Disabled...

    Science.gov (United States)

    2012-11-21

    ...)(A) of the Act specifies that the premium that these individuals will pay for CY 2013 will be equal... program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare Part A.... SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act) provides for...

  17. 76 FR 67570 - Medicare Program; Part A Premiums for CY 2012 for the Uninsured Aged and for Certain Disabled...

    Science.gov (United States)

    2011-11-01

    ... program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare Part A... will pay for CY 2012 will be equal to the premium for uninsured aged enrollees reduced by 45 percent.... SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act) provides for...

  18. 78 FR 64951 - Medicare Program; Part A Premiums for CY 2014 for the Uninsured Aged and for Certain Disabled...

    Science.gov (United States)

    2013-10-30

    ...)(A) of the Act specifies that the premium that these individuals will pay for CY 2014 will be equal... OASDI program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare...-6390. SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act...

  19. Medicare program; contracts with health maintenance organizations (HMOs) and competitive medical plans (CMPs)--HCFA. Final rule with comment period.

    Science.gov (United States)

    1995-09-01

    This rule clarifies and updates portions of the HCFA regulations that pertain to the following: The conditions that an HMO or CMP must meet to qualify for a Medicare contract (Subpart J). The contract requirements (Subpart L). The rules for enrollment, entitlement, and disenrollment of Medicare beneficiaries in a contracting HMO or CMP (Subpart K). How a Medicare contract is affected when there is change of ownership or leasing of facilities of a contracting HMO or CMP (Subpart M). These are technical and editorial changes that do not affect the substance of the regulations. They are intended to make it easier to find particular provisions, to provide overviews of the different program aspects, and to better ensure uniform understanding of the rules.

  20. Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.

    Science.gov (United States)

    Jansen, Sarah; Ball, Lauren; Lowe, Catherine

    2015-04-01

    This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.

  1. Effect of medicare payment on rural health care systems.

    Science.gov (United States)

    McBride, Timothy D; Mueller, Keith J

    2002-01-01

    Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

  2. Recovery of renal function among ESRD patients in the US medicare program.

    Directory of Open Access Journals (Sweden)

    Sumit Mohan

    Full Text Available BACKGROUND: Patients started on long term hemodialysis have typically had low rates of reported renal recovery with recent estimates ranging from 0.9-2.4% while higher rates of recovery have been reported in cohorts with higher percentages of patients with acute renal failure requiring dialysis. STUDY DESIGN: Our analysis followed approximately 194,000 patients who were initiated on hemodialysis during a 2-year period (2008 & 2009 with CMS-2728 forms submitted to CMS by dialysis facilities, cross-referenced with patient record updates through the end of 2010, and tracked through December 2010 in the CMS SIMS registry. RESULTS: We report a sustained renal recovery (i.e no return to ESRD during the available follow up period rate among Medicare ESRD patients of > 5% - much higher than previously reported. Recovery occurred primarily in the first 2 months post incident dialysis, and was more likely in cases with renal failure secondary to etiologies associated with acute kidney injury. Patients experiencing sustained recovery were markedly less likely than true long-term ESRD patients to have permanent vascular accesses in place at incident hemodialysis, while non-White patients, and patients with any prior nephrology care appeared to have significantly lower rates of renal recovery. We also found widespread geographic variation in the rates of renal recovery across the United States. CONCLUSIONS: Renal recovery rates in the US Medicare ESRD program are higher than previously reported and appear to have significant geographic variation. Patients with diagnoses associated with acute kidney injury who are initiated on long-term hemodialysis have significantly higher rates of renal recovery than the general ESRD population and lower rates of permanent access placement.

  3. 78 FR 61191 - Medicare Program; FY 2014 Inpatient Prospective Payment Systems: Changes to Certain Cost...

    Science.gov (United States)

    2013-10-03

    ... calculated by the our Office of the Actuary, to determine both the aggregate amount of empirically justified... Office of the Actuary used the March 2013 update of the Medicare Hospital Cost Report Information System..., as these hospitals do not receive a Medicare DSH payment. The CMS Office of the Actuary's final...

  4. 77 FR 25283 - Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and...

    Science.gov (United States)

    2012-04-27

    ... osteopathy, dentistry, and podiatry, as required in order to become certified by the appropriate specialty...'' (January 23, 2004, 69 FR 3434). A final rule titled ``Medicare, Medicaid, and Children's Health Insurance...

  5. 78 FR 47935 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

    Science.gov (United States)

    2013-08-06

    .... Accounting Statement 7. Conclusion B. Regulatory Flexibility Act Analysis C. Unfunded Mandates Reform Act...-eligible beneficiaries would receive their drugs through the Medicare Part D benefit, which would work... rate than higher-skilled occupations, using the [[Page 47943

  6. 75 FR 59272 - Medicare and Medicaid Programs; Announcement of an Application from a Hospital Requesting Waiver...

    Science.gov (United States)

    2010-09-27

    ... in which the hospital is located: War Memorial Hospital (Medicare provider number 51-1309), of..., Virginia Beach, VA 23453. The Hospital's Designated OPO is: Center for Organ Recovery and Education, RIDC...

  7. Medicare Coverage Database

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD...

  8. Collision course? Donald Trump, Paul Ryan, and the fate of Medicare.

    Science.gov (United States)

    Oberlander, Jonathan

    2018-04-10

    The election of Donald Trump as president of the United States raises questions about the future of Medicare. How will Medicare fare under Republican-led government? There are several compelling reasons that the Trump administration and Congressional Republicans might avoid Medicare reform, including the political risks of taking on a popular program, the difficulties the party has encountered in trying to dismantle the Patient Protection and Affordable Care Act (ACA), the importance of older Americans to the GOP coalition, and President Trump's views about Medicare. However, because of fiscal pressures and the commitment of Speaker of the House Paul Ryan and other Republicans to entitlement reform, the GOP nonetheless could end up attempting to make major changes in Medicare. Alternatively, Republican efforts to repeal and undermine the ACA could unintentionally enhance the political fortunes of proposals to expand Medicare. Consequently, the fate of Medicare during the Trump administration remains highly uncertain.

  9. 78 FR 40835 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-07-08

    ... and Labor- related Share for ESRD Facilities for CY 2014 c. Proposed Productivity Adjustment d. Calculation of the ESRDB Market Basket Update, Adjusted for Multifactor Productivity for CY 2014 4. The... Facility Performance on Clinical Measures Based on Improvement c. Proposals for Calculating Facility...

  10. 76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

    Science.gov (United States)

    2011-01-13

    ... program based on conditions for coverage. This new program will necessarily be a fluid model, subject to... rewarding better value, outcomes, and innovations instead of merely volume. Use of Measures: Public....hospitalcompare.hhs.gov , after a 30-day preview period. An interactive Web tool, this Web site assists...

  11. Physics issues of a proposed program, SPIRIT

    International Nuclear Information System (INIS)

    Ji, Hantao; Yamada, Masaaki

    2000-01-01

    Physics issues of the proposed program, SPIRIT (Self-organized Plasma with Induction, Reconnection, and Induction Techniques) are discussed. The main purpose of this program is to explore the physics of global stability and sustainment of compact toroids, including FRC (field reversed configuration) as well as low-aspect-ratio RFP (reversed field pinch), spheromak and spherical torus. (author)

  12. Evaluation of an integrated adherence program aimed to increase Medicare Part D star rating measures.

    Science.gov (United States)

    Leslie, R Scott; Tirado, Breanne; Patel, Bimal V; Rein, Philip J

    2014-12-01

    The Centers for Medicare Medicaid Services (CMS) Plan Quality and Performance Program, or Star Ratings Program, allows Medicare beneficiaries to compare quality of care among available Medicare Advantage prescription drug (MA-PD) plans and stand-alone prescription drug plans (PDPs). Health plans have increased intervention efforts and applied existing care management infrastructure as an approach to improving member medication adherence and subsequent Part D star rating performance. Independent Care Health Plan (iCare), an MA-PD plan; MedImpact Healthcare Systems, Inc. (MedImpact), a pharmacy benefits manager; and US MED, a mail order pharmacy, partnered to engage and enroll iCare's dual-eligible special needs population in an intervention designed to improve patient medication adherence and health plan performance for 3 Part D patient safety outcome measures: Medication Adherence for Oral Diabetes Medications (ODM), Medication Adherence for Hypertension (HTN), and Medication Adherence for Cholesterol (CHOL). To (a) assess the effectiveness of a coordinated member-directed medication adherence intervention and (b) determine the overall impact of the intervention on adherence rates and CMS Part D star rating adherence measures.  Administrative pharmacy claims and health plan eligibility data from MedImpact's databases were used to identify members using 3 target medication classes. Adherence was estimated by the proportion of days covered (PDC) for all members. Those members considered at high risk for nonadherence were prioritized for care management services. Risk factors were based on members' use of more than 1 target medication class, newly started therapy, and suboptimal adherence (PDC  less than  80%) in the most recent 6-month period. Data files listing member adherence rates and contact information were formatted and loaded monthly into iCare's care management system, which triggered an alert for care coordinators to counsel members on the importance

  13. 77 FR 13697 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2

    Science.gov (United States)

    2012-03-07

    ..., decreases in length of stay, increased patient safety, and reduced medical errors. There is evidence to... Medicaid section of this proposed rule (which relate to calculations of patient volume and hospital... Building is not readily available to persons without Federal government identification, commenters are...

  14. 77 FR 40951 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2012-07-11

    .... Thirty-Day Hospital Readmissions b. Efficiency c. Population/Community Health 6. Proposed Scoring for the...-96) by revising 42 CFR 413.89, Bad debts, charity, and courtesy allowances. B. Summary of the Major... current hospital wage data to account for differing wage levels in areas in which ESRD facilities are...

  15. 78 FR 72155 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-12-02

    ... and casts, and IOLs inserted in a physician's office. SUPPLEMENTARY INFORMATION: Electronic Access... rule, we did not readily have access to the 2007 utilization data for the ESRD facilities located in... the amount of the adjustment. We solicited comments on the proposal to include data on the utilization...

  16. 75 FR 21175 - Medicare and Medicaid Programs; Waiver of Disapproval of Nurse Aide Training Program in Certain...

    Science.gov (United States)

    2010-04-23

    ... within a reasonable distance of the facility; Assures that an adequate environment exists for operating... final rule on these operational issues, we will work with all interested stakeholders to develop the..., Health Records, Medicaid, Medicare, Nursing [[Page 21179

  17. 76 FR 68467 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2011

    Science.gov (United States)

    2011-11-04

    ... Stuart Caplan, (410) 786-8564 Emission Tomography Registry RN, MAS. Sites. XII Medicare-Approved JoAnna... Stuart Caplan, (410) 786-8564 Emission Tomography for RN, MAS. Dementia Trials. All Other Information...

  18. 75 FR 21329 - Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying...

    Science.gov (United States)

    2010-04-23

    ... includes payment for premiums for Medicare Part B. Section 4732 of the Balanced Budget Act of 1997 (BBA... formula for determining State allotments. However, since certain States projected a deficit in their... minimize the impact on States with FY QI allotments that might be greater than their QI expenditures for...

  19. 75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2010-10-22

    .... Palliative care in an LTC facility involves addressing physical, intellectual, emotional, social, and... Disability, Aging and Long-Term Care Policy and the Urban Institute; ``Synthesis and Analysis of Medicare..., mental, social, or emotional status; clinical complications that suggested a need to alter the care plan...

  20. 78 FR 32661 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal of the Advisory Panel on...

    Science.gov (United States)

    2013-05-31

    ... health coverage options available. The Advisory Panel on Outreach and Education allows us to consider a... Education (APOE) and Request for Nominations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... Education (APOE) has been renewed. It also requests nominations for individuals to serve on the APOE. DATES...

  1. 75 FR 8374 - Medicare Program; Meeting of the Practicing Physicians Advisory Council, March 8, 2010; Correction

    Science.gov (United States)

    2010-02-24

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1566-CN... 22, 2010 (75 FR 3743), there were a number of technical errors that are identified and corrected in... telephone at the number listed in the FOR FURTHER INFORMATION CONTACT section of this notice by the date...

  2. 76 FR 42169 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Science.gov (United States)

    2011-07-18

    ...) 786-4533, and Jana Lindquist, (410) 786-4533, Partial hospitalization and community mental health... Laboratory Fee Schedule CMHC Community Mental Health Center CMS Centers for Medicare & Medicaid Services CPT... community mental health centers (CMHCs)) and hospital outpatient services that are furnished to inpatients...

  3. 77 FR 41547 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2013...

    Science.gov (United States)

    2012-07-13

    ... national standardized 60- day episode rates, the national per-visit rates, the low-utilization payment... Care Hospital LUPA Low Utilization Payment Amount MEPS Medical Expenditures Panel Survey MMA Medicare... units of services, adjustments for geographic differences in wage levels, outlier payments, the...

  4. 75 FR 38026 - Medicare Program; Identification of Backward Compatible Version of Adopted Standard for E...

    Science.gov (United States)

    2010-07-01

    ... testimony, industry also stated that the changes that were present in NCPDP SCRIPT 10.6 created an environment where long-term care (LTC) facilities could carry out e-prescribing under Medicare Part D. They.... Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or...

  5. 75 FR 81278 - Medicare Program: Solicitation of Comments Regarding Development of a Recovery Audit Contractor...

    Science.gov (United States)

    2010-12-27

    ... Director.) Specific conflict of interest rules that should apply to RACs for the Medicare Parts C and D... Remuneration (DIR). The DIR information reported by plans includes rebates paid by pharmaceutical manufacturers, as well as other remuneration received by the plan that has the effect of reducing their drug costs...

  6. 78 FR 43281 - Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical...

    Science.gov (United States)

    2013-07-19

    ... Index MFP Multi-Factor Productivity MIEA-TRHCA The Medicare Improvements and Extension Act, Division B... calculating direct PE RVUs from the top- down to the bottom-up methodology beginning in CY 2007. We adopted a... $20 million. 2. Calculation of Payments Based on RVUs To calculate the payment for each physicians...

  7. 78 FR 74229 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical...

    Science.gov (United States)

    2013-12-10

    ... MFP Multi-Factor Productivity MGMA Medical Group Management Association MIEA-TRHCA The Medicare... 69624), we revised the methodology for calculating direct PE RVUs from the top- down to the bottom-up... Based on RVUs To calculate the payment for each physicians' service, the components of the fee schedule...

  8. 77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-06-11

    ... identify outlier cases for both inpatient operating and inpatient capital related payments, which is... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 412... Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality...

  9. 76 FR 5861 - Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements...

    Science.gov (United States)

    2011-02-02

    ... Improvement Protection Act of 2000 (Pub. L. 106-544) CAH Critical access hospital CAP Competitive acquisition... corporations and non-profit organizations and charities. The ``Report to Congress on Steps Taken to Assure... primarily payable under Part A of Medicare, such as hospitals, home health agencies (including home health...

  10. 76 FR 19365 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Science.gov (United States)

    2011-04-07

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1357-N] RIN... document, demonstrates that this notice is consistent with the regulatory philosophy and principles.... Kathleen Sebelius, Secretary, Department of Health and Human Services. Addendum This addendum includes...

  11. 77 FR 23722 - Medicare Program; Extension of Certain Wage Index Reclassifications and Special Exceptions for...

    Science.gov (United States)

    2012-04-20

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1442-N... regulatory philosophy and principles identified in Executive Order 12866 and 13563, the RFA, and section 1102.... Kathleen Sebelius, Secretary, Department of Health and Human Services. [FR Doc. 2012-9598 Filed 4-19-12; 8...

  12. 78 FR 54842 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Science.gov (United States)

    2013-09-06

    ... millions) (2) change (3) Total $3,625 1% Eye and ocular adnexa 1,496 -3 Digestive system 743 8 Nervous... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405...: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality...

  13. 76 FR 31547 - Medicare Program; Proposed Changes to the Electronic Prescribing (eRx) Incentive Program

    Science.gov (United States)

    2011-06-01

    ... Independence Avenue, SW., Washington, DC 20201. (Because access to the interior of the Hubert H. Humphrey... is, written or acoustic signals to warn the prescriber of possible undesirable or unsafe situations...

  14. 77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-05-11

    ... Considered HAC Candidate: Iatrogenic Pneumothorax With Venous Catheterization 3. Present on Admission (POA.... History of Measures Adopted for the Hospital IQR Program b. Maintenance of Technical Specifications for...-Associated Infection (HAI) Measures (A) Proposed Central Line Associated Blood Stream Infections ((CLABSI...

  15. 78 FR 26879 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2013-05-08

    ... Prospective Payment System for Federal Fiscal Year 2014; Proposed Rule #0;#0;Federal Register / Vol. 78, No... Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 AGENCY... IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data...

  16. Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

    Science.gov (United States)

    Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua

    2016-06-01

    Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims data. Presently, there is little information regarding the use of these programs among a geriatric population. To (a) quantify the prevalence of LCGP users in a nationally representative population of Medicare beneficiaries; (b) compare clinical and demographic characteristics of LCGP users and nonusers; (c) assess determinants of LCGP use and medications acquired through these programs; and (d) analyze patterns of LCGP use during the years 2007-2012. This study relied on data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2012. The first 3 objectives were completed with a cohort of individuals in the most recent MEPS panel, while the fourth objective was completed with a separate cohort composed of individuals who participated in MEPS from 2007 to 2012. Inclusion in either study cohort required that individuals were Medicare beneficiaries aged 65 years or greater, used at least 1 prescription drug during their 2-year panel period, and participated in all 5

  17. Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

    Science.gov (United States)

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

  18. Medicare Non-Utilization Project (MNUP)

    Data.gov (United States)

    Social Security Administration — A program integrity initiative using a data exchange between SSA and the Centers for Medicare and Medicaid Services (CMS).CMS will identify Medicare Part B enrollees...

  19. Statistical Uncertainty in the Medicare Shared Savings...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to analysis reported in Statistical Uncertainty in the Medicare Shared Savings Program published in Volume 2, Issue 4 of the Medicare and Medicaid Research...

  20. Medicare FFS Jurisdiction Error Rate Contribution Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services CMS is dedicated to continually strengthening and improving the Medicare program, which provides vital services to...

  1. An effectiveness and cost-benefit analysis of a hospital-based discharge transition program for elderly Medicare recipients.

    Science.gov (United States)

    Saleh, Shadi S; Freire, Chris; Morris-Dickinson, Gwendolyn; Shannon, Trip

    2012-06-01

    To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis. Randomized controlled trial. A general hospital in upstate New York State. Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months. The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow. Cost-benefit ratio of the PDCT program; self-management skills and abilities. The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities. Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  2. 75 FR 58789 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2010

    Science.gov (United States)

    2010-09-24

    ... Office of Management and Budget for collections of information in CMS regulations and a list of Medicare- approved carotid stent facilities. Included in this notice is a list of the American College of Cardiology... special one-time notices regarding national coverage provisions. Also included in this notice is a list of...

  3. 75 FR 14905 - Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2009

    Science.gov (United States)

    2010-03-26

    ... under Medicare. This notice also includes listings of all approval numbers from the Office of Management... stent facilities. Included in this notice is a list of the American College of Cardiology's National Cardiovascular Data registry sites, active CMS coverage-related guidance documents, and special one-time notices...

  4. Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program: Comment.

    Science.gov (United States)

    Ketcham, Jonathan D; Kuminoff, Nicolai V; Powers, Christopher A

    2016-12-01

    Consumers' enrollment decisions in Medicare Part D can be explained by Abaluck and Gruber’s (2011) model of utility maximization with psychological biases or by a neoclassical version of their model that precludes such biases. We evaluate these competing hypotheses by applying nonparametric tests of utility maximization and model validation tests to administrative data. We find that 79 percent of enrollment decisions from 2006 to 2010 satisfied basic axioms of consumer theory under the assumption of full information. The validation tests provide evidence against widespread psychological biases. In particular, we find that precluding psychological biases improves the structural model's out-of-sample predictions for consumer behavior.

  5. Proposed tokamak poloidal field system development program

    Energy Technology Data Exchange (ETDEWEB)

    Rogers, J.D.; Vogel, H.F.; Warren, R.W.; Weldon, D.M.

    1977-05-01

    A program is proposed to develop poloidal field components for TNS and EPR size tokamak devices and to test these components in realistic circuits. Emphasis is placed upon the development of the most difficult component, the superconducting ohmic-heating coil. Switches must also be developed for testing the coils, and this switching technology is to be extended to meet the requirements for the large scale tokamaks. Test facilities are discussed; power supplies, including a homopolar to drive the coils, are considered; and poloidal field systems studies are proposed.

  6. Does It Pay to Penalize Hospitals for Excess Readmissions? Intended and Unintended Consequences of Medicare's Hospital Readmissions Reductions Program.

    Science.gov (United States)

    Mellor, Jennifer; Daly, Michael; Smith, Molly

    2017-08-01

    To incentivize hospitals to provide better quality care at a lower cost, the Affordable Care Act of 2010 included the Hospital Readmissions Reduction Program (HRRP), which reduces payments to hospitals with excess 30-day readmissions for Medicare patients treated for certain conditions. We use triple difference estimation to identify the HRRP's effects in Virginia hospitals; this method estimates the difference in changes in readmission over time between patients targeted by the policy and a comparison group of patients and then compares those difference-in-differences estimates in patients treated at hospitals with readmission rates above the national average (i.e., those at risk for penalties) and patients treated at hospitals with readmission rates below or equal to the national average (those not at risk). We find that the HRRP significantly reduced readmission for Medicare patients treated for acute myocardial infarction (AMI). We find no evidence that hospitals delay readmissions, treat patients with greater intensity, or alter discharge status in response to the HRRP, nor do we find changes in the age, race/ethnicity, health status, and socioeconomic status of patients admitted for AMI. Future research on the specific mechanisms behind reduced AMI readmissions should focus on actions by healthcare providers once the patient has left the hospital. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Description and outcomes of a Medicare case management program by nurses.

    Science.gov (United States)

    Allen, S A

    1999-01-01

    During the current environment of cost-cutting and restructuring, case management is viewed as a means of providing comprehensive, coordinated care while reducing costs. Studies of community-based case management have been disappointing. This study evaluates a Medicare service, Management and Evaluation of the Care Plan (MAE), as a model of nurses providing case management in the home. Three groups were compared: MAE (N = 176), non-MAE (N = 187) and newly discharged (N = 93). Utilization data was collected over one year. Overall, subjects were unmarried older women with three functional limitations, four medical diagnoses and averaged 43 home care visits and one hospitalization. MAE patients were older, had more functional and environmental limitations, less ADL independence, and a worse prognosis, yet used significantly less health care than non-MAE recipients did. Regression analysis was performed using group membership and hospital and home care utilization as dependent variables. Although the project was conducted at one site, overall the sample was similar to the national Medicare population.

  8. The Role of Geography in the Assessment of Quality: Evidence from the Medicare Advantage Program.

    Directory of Open Access Journals (Sweden)

    Rene Soria-Saucedo

    Full Text Available The Affordable Care Act set in motion a renewed emphasis on quality of care evaluation. However, the evaluation strategies of quality by the Centers for Medicare and Medicaid Services do not consider geography when comparisons are made among plans. Using an overall measure of a plan's quality in the public sector--the Medicare Advantage (MA star ratings--we explored the impact of geography in these ratings. We identified 2,872 U.S counties in 2010. The geographic factor predicted a larger fraction of the MA ratings' compared to socio-demographic factors which explained less. Also, after the risk adjustments, almost half of the U.S. states changed their ranked position in the star ratings. Further, lower MA star ratings were identified in the Southeastern region. These findings suggest that the geographic component effect on the ratings is not trivial and should be considered in future adjustments of the metric, which may enhance the transparency, accountability, and importantly level the playing field more effectively when comparing quality across health plans.

  9. The Role of Geography in the Assessment of Quality: Evidence from the Medicare Advantage Program.

    Science.gov (United States)

    Soria-Saucedo, Rene; Xu, Peng; Newsom, Jack; Cabral, Howard; Kazis, Lewis E

    2016-01-01

    The Affordable Care Act set in motion a renewed emphasis on quality of care evaluation. However, the evaluation strategies of quality by the Centers for Medicare and Medicaid Services do not consider geography when comparisons are made among plans. Using an overall measure of a plan's quality in the public sector--the Medicare Advantage (MA) star ratings--we explored the impact of geography in these ratings. We identified 2,872 U.S counties in 2010. The geographic factor predicted a larger fraction of the MA ratings' compared to socio-demographic factors which explained less. Also, after the risk adjustments, almost half of the U.S. states changed their ranked position in the star ratings. Further, lower MA star ratings were identified in the Southeastern region. These findings suggest that the geographic component effect on the ratings is not trivial and should be considered in future adjustments of the metric, which may enhance the transparency, accountability, and importantly level the playing field more effectively when comparing quality across health plans.

  10. 75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

    Science.gov (United States)

    2010-11-24

    ...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security

  11. 76 FR 31338 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Science.gov (United States)

    2011-05-31

    ... Medicare program and Medicare plans design and monitor patient-centered quality improvement initiatives... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier CMS-10147, CMS-10396 and CMS-R-246] Agency Information Collection Activities: Proposed Collection...

  12. Reforming Medicare through 'version 2.0' of accountable care.

    Science.gov (United States)

    Lieberman, Steven M

    2013-07-01

    Medicare needs fundamental reform to achieve fiscal sustainability, improve value and quality, and preserve beneficiaries' access to physicians. Physician fees will fall by one-quarter in 2014 under current law, and the dire federal budget outlook virtually precludes increasing Medicare spending. There is a growing consensus among policy makers that reforming fee-for-service payment, which has long served as the backbone of Medicare, is unavoidable. Accountable care organizations (ACOs) provide a new payment alternative but currently have limited tools to control cost growth or engage and reward beneficiaries and providers. To fundamentally reform Medicare, this article proposes an enhanced version of ACOs that would eliminate the scheduled physician fee cuts, allow fees to increase with inflation, and enhance ACOs' ability to manage care. In exchange, the proposal would require modest reductions in overall Medicare spending and require ACOs to accept increased accountability and financial risk. It would cause per beneficiary Medicare spending by 2023 to fall 4.2 percent below current Congressional Budget Office projections and help the program achieve fiscal sustainability.

  13. Natural Programming: Project Overview and Proposal

    National Research Council Canada - National Science Library

    Myers, Brad

    1998-01-01

    .... The Natural Programming Project is developing general principles, methods, and programming language designs that will significantly reduce the amount of learning and effort needed to write programs...

  14. Reforming funding for chronic illness: Medicare-CDM.

    Science.gov (United States)

    Swerissen, Hal; Taylor, Michael J

    2008-02-01

    Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.

  15. 76 FR 72707 - Office of the Assistant Secretary for Planning and Evaluation; Medicare Program; Meeting of the...

    Science.gov (United States)

    2011-11-25

    ... recommendations to the Medicare Trustees on how the Trustees might more accurately estimate health spending in the long run. The Panel's discussion is expected to be very technical in nature and will focus on the... making recommendations to the Medicare Trustees on how the Trustees might more accurately project health...

  16. 76 FR 13515 - Medicare Program; Revisions to the Reductions and Increases to Hospitals' FTE Resident Caps for...

    Science.gov (United States)

    2011-03-14

    ...' FTE Resident Caps for Graduate Medical Education Payment Purposes AGENCY: Centers for Medicare... education affiliated groups for the purpose of determining possible full-time equivalent resident cap... caps for direct GME under Medicare for certain hospitals, and to authorize the ``redistribution'' of...

  17. How Successful Is Medicare Advantage?

    Science.gov (United States)

    Newhouse, Joseph P; McGuire, Thomas G

    2014-01-01

    Context Medicare Part C, or Medicare Advantage (MA), now almost 30 years old, has generally been viewed as a policy disappointment. Enrollment has vacillated but has never come close to the penetration of managed care plans in the commercial insurance market or in Medicaid, and because of payment policy decisions and selection, the MA program is viewed as having added to cost rather than saving funds for the Medicare program. Recent changes in Medicare policy, including improved risk adjustment, however, may have changed this picture. Methods This article summarizes findings from our group's work evaluating MA's recent performance and investigating payment options for improving its performance even more. We studied the behavior of both beneficiaries and plans, as well as the effects of Medicare policy. Findings Beneficiaries make “mistakes” in their choice of MA plan options that can be explained by behavioral economics. Few beneficiaries make an active choice after they enroll in Medicare. The high prevalence of “zero-premium” plans signals inefficiency in plan design and in the market's functioning. That is, Medicare premium policies interfere with economically efficient choices. The adverse selection problem, in which healthier, lower-cost beneficiaries tend to join MA, appears much diminished. The available measures, while limited, suggest that, on average, MA plans offer care of equal or higher quality and for less cost than traditional Medicare (TM). In counties, greater MA penetration appears to improve TM's performance. Conclusions Medicare policies regarding lock-in provisions and risk adjustment that were adopted in the mid-2000s have mitigated the adverse selection problem previously plaguing MA. On average, MA plans appear to offer higher value than TM, and positive spillovers from MA into TM imply that reimbursement should not necessarily be neutral. Policy changes in Medicare that reform the way that beneficiaries are charged for MA plan

  18. 77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Science.gov (United States)

    2012-01-04

    ... lines was not applied correctly. We have corrected our programming logic in the OPPS data process to... made to the programming logic described in the CY 2012 OPPS/ASC final (see 76 FR 74141). The correct...

  19. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Science.gov (United States)

    2010-10-01

    ... reimbursement for approved nursing and allied health education programs and the methodology for determining the... receives payment for a nursing or allied health education program under § 413.85 may receive an additional... establishes a nursing or allied health education program after FY 1998 and receives reasonable cost payment...

  20. 77 FR 24409 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Science.gov (United States)

    2012-04-24

    ..., to correct our programming logic in the OPPS data process to apply the line item trim correctly. We... center crosswalk in our programming logic and the packaging status of two drug codes. III. Summary of... dataset used to model the OPPS. In reviewing the program logic used to establish the APC median costs for...

  1. COMPETITIVE BIDDING IN MEDICARE ADVANTAGE: EFFECT OF BENCHMARK CHANGES ON PLAN BIDS

    Science.gov (United States)

    Song, Zirui; Landrum, Mary Beth; Chernew, Michael E.

    2013-01-01

    Bidding has been proposed to replace or complement the administered prices in Medicare pays to hospitals and health plans. In 2006, the Medicare Advantage program implemented a competitive bidding system to determine plan payments. In perfectly competitive models, plans bid their costs and thus bids are insensitive to the benchmark. Under many other models of competition, bids respond to changes in the benchmark. We conceptualize the bidding system and use an instrumental variable approach to study the effect of benchmark changes on bids. We use 2006–2010 plan payment data from the Centers for Medicare and Medicaid Services, published county benchmarks, actual realized fee-for-service costs, and Medicare Advantage enrollment. We find that a $1 increase in the benchmark leads to about a $0.53 increase in bids, suggesting that plans in the Medicare Advantage market have meaningful market power. PMID:24308881

  2. Competitive bidding in Medicare Advantage: effect of benchmark changes on plan bids.

    Science.gov (United States)

    Song, Zirui; Landrum, Mary Beth; Chernew, Michael E

    2013-12-01

    Bidding has been proposed to replace or complement the administered prices that Medicare pays to hospitals and health plans. In 2006, the Medicare Advantage program implemented a competitive bidding system to determine plan payments. In perfectly competitive models, plans bid their costs and thus bids are insensitive to the benchmark. Under many other models of competition, bids respond to changes in the benchmark. We conceptualize the bidding system and use an instrumental variable approach to study the effect of benchmark changes on bids. We use 2006-2010 plan payment data from the Centers for Medicare and Medicaid Services, published county benchmarks, actual realized fee-for-service costs, and Medicare Advantage enrollment. We find that a $1 increase in the benchmark leads to about a $0.53 increase in bids, suggesting that plans in the Medicare Advantage market have meaningful market power. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. A proposal of neutron science research program

    International Nuclear Information System (INIS)

    Suzuki, Y.; Yasuda, H.; Tone, T.; Mizumoto, M.

    1996-01-01

    A conception of Neutron Science Research Program (NSRP) has been proposed in Japan Atomic Energy Research Institute (JAERI) since 1994 as a future big project. The NSRP aims at exploring new basic science and nuclear energy science by a high-intensity proton accelerator. It is a complex composed of a proton linac and seven research facilities with each different target system. The proton linac is required to supply the high-intensity proton beam with energy up to 1.5 GeV and current 10 mA on average. The scientific research facilities proposed, are as follows: Thermal/Cold Neutron Facility for the neutron scattering experiments, Neutron Irradiation Facility for materials science, Neutron Physics Facility for nuclear data measurement, OMEGA/Nuclear Energy Facility for nuclear waste transmutation and fuel breeding, Spallation RI Beam Facility for nuclear physics, Meson/Muon Facility for meson and muon physics and their applications and Medium Energy Beam Facility for accelerator technology development, medical use, etc. Research and development have been carried out for the components of the injector system of the proton linac; an ion source, an RFQ linac and a part of DTL linac. The conceptual design work and research and development activities for NSRP have been started in the fiscal year, 1996. Construction term will be divided into two phases; the completion of the first phase is expected in 2003, when the proton linac will produce 1.5 GeV, 1 mA beam by reflecting the successful technology developments. (author)

  4. 76 FR 25787 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

    Science.gov (United States)

    2011-05-05

    ... comments. Comments received timely will also be available for public inspection, generally beginning... Array Deep Brain Stimulation System 3. MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat...

  5. 75 FR 29479 - Medicare and Medicaid Programs: Proposed Changes Affecting Hospital and Critical Access Hospital...

    Science.gov (United States)

    2010-05-26

    ... osteopathy at the CAH must be evaluated by one of these same three types of outside parties. These... diagnosis and treatment furnished by doctors of medicine or osteopathy at the CAH are evaluated by-- (i) One...

  6. 77 FR 34047 - Medicare Program; Proposal Evaluation Criteria and Standards for End Stage Renal Disease (ESRD...

    Science.gov (United States)

    2012-06-08

    ... by section 1881(c)(2) of the Act. These functions are to: Encourage participation in vocational... strives to promote health care that is respectful of and responsive to individual patient preferences...

  7. 78 FR 4151 - Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health...

    Science.gov (United States)

    2013-01-18

    ...) Program using the Quality Reporting Document Architecture (QRDA) Category I. The comment period for the.... (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons... Reporting (IQR) Program using the Quality Reporting Document Architecture (QRDA) Category I beginning with...

  8. 77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-08-31

    ... Estimated Net Savings for Current HACs g. Previously Considered Candidate HACs--RTI Analysis of Frequency of... Program 1. Background 2. Budget Neutrality Offset Amount for FY 2013 L. Hospital Routine Services... Program a. Administrative Requirements (1) Requirements Regarding QualityNet Account and Administrator for...

  9. Clinical Informatics Fellowship Programs: In Search of a Viable Financial Model: An open letter to the Centers for Medicare and Medicaid Services.

    Science.gov (United States)

    Lehmann, C U; Longhurst, C A; Hersh, W; Mohan, V; Levy, B P; Embi, P J; Finnell, J T; Turner, A M; Martin, R; Williamson, J; Munger, B

    2015-01-01

    In the US, the new subspecialty of Clinical Informatics focuses on systems-level improvements in care delivery through the use of health information technology (HIT), data analytics, clinical decision support, data visualization and related tools. Clinical informatics is one of the first subspecialties in medicine open to physicians trained in any primary specialty. Clinical Informatics benefits patients and payers such as Medicare and Medicaid through its potential to reduce errors, increase safety, reduce costs, and improve care coordination and efficiency. Even though Clinical Informatics benefits patients and payers, because GME funding from the Centers for Medicare and Medicaid Services (CMS) has not grown at the same rate as training programs, the majority of the cost of training new Clinical Informaticians is currently paid by academic health science centers, which is unsustainable. To maintain the value of HIT investments by the government and health care organizations, we must train sufficient leaders in Clinical Informatics. In the best interest of patients, payers, and the US society, it is therefore critical to find viable financial models for Clinical Informatics fellowship programs. To support the development of adequate training programs in Clinical Informatics, we request that the Centers for Medicare and Medicaid Services (CMS) issue clarifying guidance that would allow accredited ACGME institutions to bill for clinical services delivered by fellows at the fellowship program site within their primary specialty.

  10. 76 FR 71571 - Medicare Program; Town Hall Meeting on FY 2013 Applications for New Medical Services and...

    Science.gov (United States)

    2011-11-18

    ... a diagnosis affects the management of the patient. Use of the device significantly improves clinical... Payments Under the Hospital Inpatient Prospective Payment System AGENCY: Centers for Medicare & Medicaid... and technologies under the hospital inpatient prospective payment system (IPPS). Interested parties...

  11. Medicare program; replacement of reasonable charge methodology by fee schedules for parenteral and enteral nutrients, equipment, and supplies. Final rule.

    Science.gov (United States)

    2001-08-28

    This final rule implements fee schedules for payment of parenteral and enteral nutrition (PEN) items and services furnished under the prosthetic device benefit, defined in section 1861(s)(8) of the Social Security Act. The authority for establishing these fee schedules is provided by the Balanced Budget Act of 1997, which amended the Social Security Act at section 1842(s). Section 1842(s) of the Social Security Act specifies that statewide or other area wide fee schedules may be implemented for the following items and services still subject to the reasonable charge payment methodology: medical supplies; home dialysis supplies and equipment; therapeutic shoes; parenteral and enteral nutrients, equipment, and supplies; electromyogram devices; salivation devices; blood products; and transfusion medicine. This final rule describes changes made to the proposed fee schedule payment methodology for these items and services and provides that the fee schedules for PEN items and services are effective for all covered items and services furnished on or after January 1, 2002. Fee schedules will not be implemented for electromyogram devices and salivation devices at this time since these items are not covered by Medicare. In addition, fee schedules will not be implemented for medical supplies, home dialysis supplies and equipment, therapeutic shoes, blood products, and transfusion medicine at this time since the data required to establish these fee schedules are inadequate.

  12. 76 FR 4997 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

    Science.gov (United States)

    2011-01-27

    ... Chemicals cost category, we used a blended PPI composed of the PPI for Industrial Gases, the PPI for Other... using the PPI for Commercial Natural Gas (BLS series code WPU0552). For the proposed FY 2008-based...

  13. 76 FR 48485 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

    Science.gov (United States)

    2011-08-08

    ... index budget neutrality factor, described later in this section. Tables 2 and 3 reflect the updated..., for a net market basket increase factor of 1.7 percent. As discussed in the FY 2012 proposed rule, the...

  14. Natural Programming: Project Overview and Proposal

    National Research Council Canada - National Science Library

    Myers, Brad

    1998-01-01

    End-users must write programs to control many different kinds of applications. Examples include multimedia authoring, controlling robots, defining manufacturing processes, setting up simulations, programming agents, scripting, etc...

  15. Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule & other revisions to Part B for CY 2014. Final rule with comment period.

    Science.gov (United States)

    2013-12-10

    This major final rule with comment period addresses changes to the physician fee schedule, clinical laboratory fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs. (See the Table of Contents for a listing of the specific issues addressed in the final rule with comment period.)

  16. The Hospital-Acquired Conditions (HAC) reduction program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties.

    Science.gov (United States)

    Saitone, T L; Sexton, R J; Sexton Ward, A

    2018-01-01

    The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals' HAC scores and likelihood of avoiding the Medicare-reimbursement penalty. A simulation model is developed and implemented using public data from the CMS' Hospital Compare website to determine how hospitals' unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals' HAC scores. Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction. The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter

  17. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

    Science.gov (United States)

    2012-11-15

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

  18. Canadian Medicare: prognosis guarded.

    OpenAIRE

    Naylor, C D; Fooks, C; Williams, J I

    1995-01-01

    Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making ...

  19. Medicare Appeals Council Decisions

    Data.gov (United States)

    U.S. Department of Health & Human Services — Decisions of the Departmental Appeals Board's Medicare Appeals Council involving claims for entitlement to Medicare and individual claims for Medicare coverage and...

  20. Medicare Hospice Benefits

    Science.gov (United States)

    CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who’s eligible for hospice care What services are included in hospice care How ...

  1. 75 FR 43235 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-07-23

    ... Hypertension''), fail to include the NHLBI Blood Pressure (BP) guidelines and classification terminology. The.... Updates to the HH PPS II. Provisions of the Proposed Regulation A. Case-Mix Measurement B. Hypertension... points for secondary diagnoses, whereas the system prior to the refinements did not. Longstanding OASIS...

  2. 75 FR 21207 - Medicare Program; Ambulatory Surgical Centers, Conditions for Coverage

    Science.gov (United States)

    2010-04-23

    ... physician's referral. In addition, we are proposing some other minor changes to the CfC for patient right... current CfC for patient rights to include an exception that would allow an ASC to provide patients or the patients' representative or surrogate with required patient rights information on the day of the procedure...

  3. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-06-27

    ... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

  4. 76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2011-08-18

    ...-Associated Secondary Diagnoses for Current HACs h. RTI Analysis of Estimated Net Savings for Current HACs i.... Changes to the Demonstration Program Made by the Affordable Care Act 3. FY 2012 Budget Neutrality Adjustment a. Component of the FY 2012 Budget Neutrality Adjustment that Accounts for Estimated Demonstration...

  5. How State-Funded Home Care Programs Respond to Changes in Medicare Home Health Care: Resource Allocation Decisions on the Front Line

    Science.gov (United States)

    Corazzini, Kirsten

    2003-01-01

    Objective To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Data Sources/Study Setting Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Study Design Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N=2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Data Collection/Extraction Methods Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Principal Findings Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Conclusions Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. PMID:14596390

  6. The Impact of Hospital-Acquired Conditions on Medicare..

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Impact of Hospital-Acquired Conditions on Medicare Program Payments, published in Volume 4, Issue 4 of the Medicare and...

  7. Research waste management program - An action proposal

    International Nuclear Information System (INIS)

    Costa Ramos, A.; Esposito, I.

    1997-01-01

    The Brazilian Nuclear Energy Commission planned prepared and established a Research Waste Management Program, started in 1996, in order to map, to analyze and to solve the common problems in the research field. The specific study done included a large number of academic institutions. The procedures, results and operational methodology used by the Team linked to the Program, in one of the research institutions studied where corrective actions were implemented to avoid unnecessary dose to the public, will be discussed in this article. (author)

  8. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

    Science.gov (United States)

    2017-08-03

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

  9. Cognition, Health Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medicare Beneficiaries.

    Science.gov (United States)

    Sivakumar, Haran; Hanoch, Yaniv; Barnes, Andrew J; Federman, Alex D

    2016-01-01

    Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p information about the Medicare program and diminish their ability to make fully informed choices.

  10. Federal Aviation Administration retained savings program proposal

    International Nuclear Information System (INIS)

    Hostick, D.J.; Larson, L.L.; Hostick, C.J.

    1998-03-01

    Federal legislation allows federal agencies to retain up to 50% of the savings associated with implementing energy efficiency and water conservation measures and practices. Given budget pressures to reduce expenditures, the use of retained savings to fund additional projects represents a source of funds outside of the traditional budget cycle. The Southwest Region Federal Aviation Administration (FAA) has tasked Pacific Northwest National Laboratory (PNNL) to develop a model retained savings program for Southwest Region FAA use and as a prototype for consideration by the FAA. PNNL recommends the following steps be taken in developing a Southwest Region FAA retained savings program: Establish a retained savings mechanism. Determine the level at which the retained savings should be consolidated into a fund. The preliminary recommendation is to establish a revolving efficiency loan fund at the regional level. Such a mechanism allows some consolidation of savings to fund larger projects, while maintaining a sense of facility ownership in that the funds will remain within the region

  11. 77 FR 70163 - Medicare Program; Town Hall Meeting on FY 2014 Applications for New Medical Services and...

    Science.gov (United States)

    2012-11-23

    ... evidence that use of the device to make a diagnosis affects the management of the patient. Use of the... the device. ++ Decreased pain, bleeding or other quantifiable symptoms. ++ Reduced recovery time. In... technology that substantially improves the diagnosis or treatment of Medicare beneficiaries before...

  12. 78 FR 71555 - Medicare Program; Town Hall Meeting on FY 2015 Applications for New Medical Services and...

    Science.gov (United States)

    2013-11-29

    ... evidence that use of the device to make a diagnosis affects the management of the patient. Use of the... the device. ++ Decreased pain, bleeding or other quantifiable symptoms. ++ Reduced recovery time. In... technology that substantially improves the diagnosis or treatment of Medicare beneficiaries before...

  13. 75 FR 68798 - Medicare Program; Part A Premiums for CY 2011 for the Uninsured Aged and for Certain Disabled...

    Science.gov (United States)

    2010-11-09

    ... Retirement Act and certain others do not have to pay premiums for Medicare Part A.) Section 1818A of the Act... specifies that the premium that these individuals will pay for CY 2011 will be equal to the premium for... consequential effect on State, local, or tribal governments or on the private sector. However, States are...

  14. 76 FR 32409 - Medicare Program; Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule

    Science.gov (United States)

    2011-06-06

    .../Kyphoplasty 7. Closed Treatment of Distal Radial Fracture 8. Orthopaedic Surgery--Thigh/Knee 9. Treatment of Ankle Fracture 10. Orthopaedic Surgery/Podiatry 11. Application of Cast and Strapping 12. Cardiothoracic... Immunology MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173) MMSV...

  15. 75 FR 76468 - Office of the Assistant Secretary for Planning and Evaluation; Medicare Program; Meeting of the...

    Science.gov (United States)

    2010-12-08

    ... recommendations to the Medicare Trustees on how the Trustees might more accurately estimate health spending in the long run. The Panel's discussion is expected to be very technical in nature and will focus on the... Trustees on how the Trustees might more accurately estimate the long term rate of health spending in the...

  16. 77 FR 31359 - Medicare and Medicaid Programs; Announcement of the Re-Approval of the Joint Commission as an...

    Science.gov (United States)

    2012-05-25

    ... Organization Under the Clinical Laboratory Improvement Amendments of 1988 AGENCY: Centers for Medicare... Commission for re-approval as an accreditation organization for clinical laboratories under the Clinical... On October 31, 1988, the Congress enacted the Clinical Laboratory Improvement Amendments of 1988...

  17. 76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

    Science.gov (United States)

    2011-04-06

    ... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...

  18. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  19. Newspaper Coverage of the Harvard Medicare Project: Regional Distinctions/Discreet Disregard?

    Science.gov (United States)

    Payne, J. Gregory

    A study examined American newspaper coverage of the Harvard Medicare Project proposal of 1986, a major health policy proposal calling for comprehensive reforms in the national health program. Using Burrelle's news clipping service which includes every daily newspaper (over 1500) in the United States, all 75 newspaper articles on the project from…

  20. Object oriented distributed programming: studies and proposals

    International Nuclear Information System (INIS)

    Guerraoui, Rachid

    1992-01-01

    This thesis contributes to the investigation of the object concept in distributed programming. Henceforth, this programming style has become a reality in the computer science world, since it allows to increase of the availability of applications and to decrease their execution time. Nevertheless, designing a distributed application is a hard task: the various abstraction levels that must be considered hinder the software reusability and maintenance, while errors and concurrent accesses are often sources of executions incoherence. The object concept improves the software modularity, and raises the computing abstraction level. Integrating distribution related aspects into the object model brings up the issues of expressing the concurrency and maintaining the coherency. The investigation of these problems in this thesis has been guided by a major concern for the preservation of the intrinsic properties of object-orientation, and the orthogonality of the solutions given. The main contributions of the thesis are: (i) the classification, regarding modularity, of the different design alternatives for object-oriented concurrent languages; (ii) the evaluation of various transactional mechanisms in object-based concurrent languages, and the design of an atomic asynchronous communication protocol named ACS; (iii) the definition of a transaction-based object-oriented concurrent language called KAROS; (iv) the implementation of a modular framework which allows to combine in a same application, various concurrency control and error recovery mechanisms; (v) the identification of a formal property, named general atomicity, which constitutes a correctness criteria for atomic objects specifications. (author) [fr

  1. Pre-Medicare Eligible Individuals' Decision-Making In Medicare Part D: An Interview Study

    Directory of Open Access Journals (Sweden)

    Tao Jin

    2010-01-01

    Full Text Available Objectives: The objective of this study was to elicit salient beliefs among pre-Medicare eligible individuals regarding (1 the outcomes associated with enrolling in the Medicare Part D program; (2 those referents who might influence participants' decisions about enrolling in the Part D program; and (3 the perceived barriers and facilitators facing those considering enrolling in the Part D program. Methods: Focused interviews were used for collecting data. A sample of 10 persons between 62 and 64 years of age not otherwise enrolled in the Medicare program was recruited. Interviews were audio taped and field notes were taken concurrently. Audio recordings were reviewed to amend field notes until obtaining a thorough reflection of interviews. Field notes were analyzed to elicit a group of beliefs, which were coded into perceived outcomes, the relevant others who might influence Medicare Part D enrollment decisions and perceived facilitators and impediments. By extracting those most frequently mentioned beliefs, modal salient sets of behavioral beliefs, relevant referents, and control beliefs were identified. Results: Analyses showed that (1 most pre-Medicare eligible believed that Medicare Part D could "provide drug coverage", "save money on medications", and "provide financial and health security in later life". However, "monthly premiums", "the formulary with limited drug coverage" and "the complexity of Medicare Part D" were perceived as major disadvantages; (2 immediate family members are most likely to influence pre-Medicare eligible's decisions about Medicare Part D enrollment; and (3 internet and mailing educational brochures are considered to be most useful resources for Medicare Part D enrollment. Major barriers to enrollment included the complexity and inadequacy of insurance plan information. Conclusion: There are multiple factors related to decision-making surrounding the Medicare Part D enrollment. These factors include the advantages

  2. TEACHING ADMINISTRATION: PROPOSAL OF THE PROGRAM CONTENT

    Directory of Open Access Journals (Sweden)

    Eduardo Ribeiro Rodrigues

    2016-08-01

    Full Text Available The National Curriculum Guidelines established by MEC (Brazilian Ministry of Education, define the specific areas of vocational training content that should be included in the curricular organization of undergraduate courses in Brazil, without suggesting or detailing which content should be offered in each area. In this sense, this study aims at proposing the course syllabus for the financial area for the undergraduate courses of Management. To achieve this goal, the curriculum matrices and the teaching plans of the financial discipline of the undergraduate courses on Management with the highest grades in ENADE were analyzed. Based on this survey, seven disciplines were elaborated with the professional qualification contents of the area, with 560 hours/class in total, distributed in the curriculum matrix, according to their goals: presentation of corporate finance and personal finance, short and long-term financial decisions, financial economic analysis, financial planning, and financial strategies.

  3. 100-N pilot project: Proposed consolidated groundwater monitoring program

    International Nuclear Information System (INIS)

    Borghese, J.V.; Hartman, M.J.; Lutrell, S.P.; Perkins, C.J.; Zoric, J.P.; Tindall, S.C.

    1996-11-01

    This report presents a proposed consolidated groundwater monitoring program for the 100-N Pilot Project. This program is the result of a cooperative effort between the Hanford Site contractors who monitor the groundwater beneath the 100-N Area. The consolidation of the groundwater monitoring programs is being proposed to minimize the cost, time, and effort necessary for groundwater monitoring in the 100-N Area, and to coordinate regulatory compliance activities. The integrity of the subprograms requirements remained intact during the consolidation effort. The purpose of this report is to present the proposed consolidated groundwater monitoring program and to summarize the process by which it was determined

  4. Use of Medicare's Diabetes Self-Management Training Benefit

    Science.gov (United States)

    Strawbridge, Larisa M.; Lloyd, Jennifer T.; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.

    2015-01-01

    Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to…

  5. Medicare Update: Annual Wellness Visit

    Science.gov (United States)

    ... counseling services or programs, designed to reduce risk factors, such as for weight loss, smoking cessation, fall prevention, and nutrition. • Review of the responses to the Health Risk Assessment Prepared by Leslie Fried, Alzheimer’s Association Medicare Advocacy Project. Rev. Feb 1, 2012 ...

  6. Medicare and Rural Health

    Science.gov (United States)

    ... community has a significant impact on the local economy. In rural areas, Medicare reimbursement is a critical source of that healthcare spending, particularly since the higher percentage of elderly population in rural areas mean that Medicare accounts for ...

  7. Medicare Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicare certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor. The cost report contains provider...

  8. Medicare Current Beneficiary Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Characteristics and Perceptions of the Medicare Population Data from the 2010 Medicare Current Beneficiary Survey is a series of source books based on the...

  9. State Policies Influence Medicare Telemedicine Utilization.

    Science.gov (United States)

    Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem

    2016-01-01

    Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs

  10. Your Medicare Benefits

    Science.gov (United States)

    ... schedule a lung cancer screening counseling and shared decision making visit with your doctor to discuss the benefits ... when they’re available in your MyMedicare.gov account. 58 Section 3: For more information Visit Medicare. gov for general information about Medicare ...

  11. Medicare Prescription Drug Coverage - General Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The MMA legislation provides seniors and people with disabilities with the first comprehensive prescription drug benefit ever offered under the Medicare program, the...

  12. Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2015-11-05

    This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

  13. Canadian Medicare: prognosis guarded.

    Science.gov (United States)

    Naylor, C D; Fooks, C; Williams, J I

    1995-08-01

    Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making across-the-board cuts. (3) Replace blame with praise:give health care professionals and institutions credit for their contributions. (4) Learn from the successful programs and policies already in place across the country. (5) Foster horizontal and vertical integration of services. (6) Promote physician leadership by rewarding efforts to promote the efficient use of resources. (7) Monitor the effects of cutbacks: physician groups should cooperate with government in maintaining a national "report card" on services, costs and the health status of Canadians.

  14. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR)

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  15. Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program.

    Science.gov (United States)

    Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E

    2017-08-01

    Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then

  16. 75 FR 69037 - Medicaid Program; Recovery Audit Contractors

    Science.gov (United States)

    2010-11-10

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 455 [CMS-6034-P] RIN 0938-AQ19 Medicaid Program; Recovery Audit Contractors AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would provide guidance to...

  17. Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

    Science.gov (United States)

    Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

    2018-02-21

    The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p reimbursement (p reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that

  18. 78 FR 40084 - Proposed Requirement-Migrant Education Program Consortium Incentive Grant Program

    Science.gov (United States)

    2013-07-03

    ... DEPARTMENT OF EDUCATION 34 CFR Chapter II Proposed Requirement--Migrant Education Program... educational agencies (SEAs) under the Migrant Education Program (MEP) Consortium Incentive Grant (CIG) Program... the interstate or intrastate coordination of migrant education programs by addressing key needs of...

  19. Proposal of programming standards for a computerized protection system

    International Nuclear Information System (INIS)

    Ehrenberger, W.; Voges, U.

    1975-05-01

    In process computer systems with high safety and reliability requirements, correctness of the software has to be proved. During the development of a program specific guidelines should be met in order to facilitate the verification of its correctness. This paper is a collection of relevant proposals. (orig.) [de

  20. Proposal for Supply Chain Concentration in the Traditional MBA Program

    Science.gov (United States)

    Ramaswamy, K. V.

    2012-01-01

    The purpose of this proposal is to develop and implement a concentration in Supply Chain Management in the existing traditional MBA program effective fall 2012. Houston is the hub for many multinational oil and energy companies, large healthcare systems, wholesale/retail businesses, engineering and construction companies, and is a major city along…

  1. Competitive bidding in Medicare: who benefits from competition?

    Science.gov (United States)

    Song, Zirui; Landrum, Mary Beth; Chernew, Michael E

    2012-09-01

    To conduct the first empirical study of competitive bidding in Medicare. We analyzed 2006-2010 Medicare Advantage data from the Centers for Medicare and Medicaid Services using longitudinal models adjusted for market and plan characteristics. A $1 increase in Medicare's payment to health maintenance organization (HMO) plans led to a $0.49 (P service plans included, higher Medicare payments increased bids less ($0.33 per dollar), suggesting more competition among these latter plans. As a market-based alternative to cost control through administrative pricing, competitive bidding relies on private insurance plans proposing prices they are willing to accept for insuring a beneficiary. However, competition is imperfect in the Medicare bidding market. As much as half of every dollar in increased plan payment went to higher bids rather than to beneficiaries. While having more insurers in a market lowered bids, the design of any bidding system for Medicare should recognize this shortcoming of competition.

  2. Is expanding Medicare coverage cost-effective?

    Directory of Open Access Journals (Sweden)

    Muennig Peter

    2005-03-01

    Full Text Available Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.

  3. Medicare program; revision to accrual basis of accounting policy. Health Care Financing Administration (HCFA), HHS. Final rule.

    Science.gov (United States)

    1999-09-27

    Medicare policy provides that payroll taxes that a provider becomes obligated to remit to governmental agencies are included in allowable costs only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in 1 year but not paid until the next year, the associated payroll taxes are not an allowable cost until the next year. This final rule provides for an exception when payment would be made to the employee in the current year but for the fact the regularly scheduled payment date is after the end of the year. In that case, the rule requires allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this rule is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on end-of-the-year payroll is allowable in the current period rather than in the following period.

  4. Medicare Modernization Act (MMA) IRS Medicare Part D

    Data.gov (United States)

    Social Security Administration — SSA uses the Internal Revenue Service (IRS) information in determing the eligibility of Medicare recipients to receive subsidy payments for Medicare premiums. SSA...

  5. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    Science.gov (United States)

    2014-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

  6. Financial Performance of Rural Medicare ACOs.

    Science.gov (United States)

    Nattinger, Matthew C; Mueller, Keith; Ullrich, Fred; Zhu, Xi

    2018-12-01

    The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan. Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance. Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted. © 2016 National Rural Health Association.

  7. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

    Science.gov (United States)

    2013-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  8. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and the Merit-based Incentive Payment System.

    Science.gov (United States)

    Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

    2017-06-01

    As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment. Quality will replace the Physician Quality Reporting System and clinicians will report on 6 measures from a list of over 250 options. Advancing care information will replace meaningful use and will assess clinicians on activities related to integration of electronic health record technology into their practice. Improvement activities will require clinicians to attest to completion of activities focused on improvements in care coordination, beneficiary engagement, and patient safety. Finally, cost will be determined automatically from Medicare claims data. In this article, we will provide a detailed review of the Medicare Access and Children's Health Insurance Program Reauthorization Act with a focus on MIPS and briefly discuss the potential implications for dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Pre-Medicare Eligible Individuals’ Decision-Making In Medicare Part D: An Interview Study

    Directory of Open Access Journals (Sweden)

    Tao Jin, B.S. Pharm, Ph.D. Candidate

    2010-01-01

    Full Text Available ObjectivesThe objective of this study was to elicit salient beliefs among pre-Medicare eligible individuals regarding (1 the outcomes associated with enrolling in the Medicare Part D program; (2 those referents who might influence participants’ decisions about enrolling in the Part D program; and (3 the perceived barriers and facilitators facing those considering enrolling in the Part D program.MethodsFocused interviews were used for collecting data. A sample of 10 persons between 62 and 64 years of age not otherwise enrolled in the Medicare program was recruited. Interviews were audio taped and field notes were taken concurrently. Audio recordings were reviewed to amend field notes until obtaining a thorough reflection of interviews. Field notes were analyzed to elicit a group of beliefs, which were coded into perceived outcomes, the relevant others who might influence Medicare Part D enrollment decisions and perceived facilitators and impediments. By extracting those most frequently mentioned beliefs, modal salient sets of behavioral beliefs, relevant referents, and control beliefs were identified.ResultsAnalyses showed that (1 most pre-Medicare eligible believed that Medicare Part D could “provide drug coverage”, “save money on medications”, and “provide financial and health security in later life”. However, “monthly premiums”, “the formulary with limited drug coverage” and “the complexity of Medicare Part D” were perceived as major disadvantages; (2 immediate family members are most likely to influence pre-Medicare eligible’s decisions about Medicare Part D enrollment; and (3 internet and mailing educational brochures are considered to be most useful resources for Medicare Part D enrollment. Major barriers to enrollment included the complexity and inadequacy of insurance plan information.ConclusionThere are multiple factors related to decision-making surrounding the Medicare Part D enrollment. These factors

  10. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    Science.gov (United States)

    2016-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  11. GRI proposes to hold the line on research program

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that the Gas Research Institute has proposed a 1993 US research and development program totaling $201.8 million, the same level as the 1991 but down from $212.9 million this year. GRI filed the 1993 proposal and its 1993-97 R and D plan with the Federal Energy Regulatory Commission. If FERC approves the plan, interstate gas pipeline companies would support the GRI research by collecting a surcharge of 1.51 cents/Mcf on nondiscounted gas transactions and 8 cents/Mcf/month on uniform demand or reservations. The proposed budget is based on a revised funding mechanism FERC is considering for GRI. The research agency's general expanses and capital budget would remain at the 1992 level of $9.8 million

  12. Public/private partnerships for prescription drug coverage: policy formulation and outcomes in Quebec's universal drug insurance program, with comparisons to the Medicare prescription drug program in the United States.

    Science.gov (United States)

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

    2007-09-01

    In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.

  13. Demand for a Medicare prescription drug benefit: exploring consumer preferences under a managed competition framework.

    Science.gov (United States)

    Cline, Richard R; Mott, David A

    2003-01-01

    Several proposals for adding a prescription drug benefit to the Medicare program rely on consumer choice and market forces to promote efficiency. However, little information exists regarding: 1) the extent of price sensitivity for such plans among Medicare beneficiaries, or 2) the extent to which drug-only insurance plans using various cost-control mechanisms might experience adverse selection. Using data from a survey of elderly Wisconsin residents regarding their likely choices from a menu of hypothetical drug plans, we show that respondents are likely to be price sensitive with respect to both premiums and out-of-pocket costs but that selection problems may arise in these markets. Outside intervention may be necessary to ensure the feasibility of a market-based approach to a Medicare drug benefit.

  14. Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Final rule.

    Science.gov (United States)

    1994-07-15

    This final rule implements sections 9312(c)(2), 9312(f), and 9434(b) of Public Law 99-509, section 7 of Public Law 100-93, section 4014 of Public Law 100-203, sections 224 and 411(k)(12) of Public Law 100-360, and section 6411(d)(3) of Public Law 101-239. These provisions broaden the Secretary's authority to impose intermediate sanctions and civil money penalties on health maintenance organizations (HMOs), competitive medical plans, and other prepaid health plans contracting under Medicare or Medicaid that (1) substantially fail to provide an enrolled individual with required medically necessary items and services; (2) engage in certain marketing, enrollment, reporting, or claims payment abuses; or (3) in the case of Medicare risk-contracting plans, employ or contract with, either directly or indirectly, an individual or entity excluded from participation in Medicare. The provisions also condition Federal financial participation in certain State payments on the State's exclusion of certain prohibited entities from participation in HMO contracts and waiver programs. This final rule is intended to significantly enhance the protections for Medicare beneficiaries and Medicaid recipients enrolled in a HMO, competitive medical plan, or other contracting organization under titles XVIII and XIX of the Social Security Act.

  15. Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease.

    Directory of Open Access Journals (Sweden)

    Fang Chen

    Full Text Available Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above and the Medicare program. Intensive Behavioral Counseling (IBC interventions like the National Diabetes Prevention Program (NDPP, have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP.Participants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years, $3,840 to $4,240 (5 years and $11,550 to $14,200 (10 years. The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound or minimal weight re-gain aligned with age-adjusted national averages (upper bound. The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27-41% for participants with prediabetes, and stroke by approximately 15% over 5 years.A digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.

  16. 75 FR 52487 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Science.gov (United States)

    2010-08-26

    ... of services. FOR FURTHER INFORMATION CONTACT: Rebecca Cole, (410) 786-4497. SUPPLEMENTARY INFORMATION...). On page 40180, in our discussion of the four disease modules covered by the proposed PQRI group... disease modules. On page 40186, in our discussion of the proposed Physician Quality Reporting Initiative...

  17. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

    Science.gov (United States)

    2016-11-04

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

  18. 78 FR 9057 - Medicare Program; Request for Information on the Use of Clinical Quality Measures (CQMs) Reported...

    Science.gov (United States)

    2013-02-07

    ... Physician Quality Reporting System (PQRS), the Electronic Health Record (EHR) Incentive Program, and Other... Physician Quality Reporting System (PQRS), as well as the Electronic Health Record (EHR) Incentive Program.... Maintenance of Certification Twenty-four member boards of the American Board of Medical Specialties (ABMS...

  19. How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

    Science.gov (United States)

    Willink, Amber; Shoen, Cathy; Davis, Karen

    2018-01-01

    The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

  20. Cost estimate for a proposed GDF Suez LNG testing program

    Energy Technology Data Exchange (ETDEWEB)

    Blanchat, Thomas K.; Brady, Patrick Dennis; Jernigan, Dann A.; Luketa, Anay Josephine; Nissen, Mark R.; Lopez, Carlos; Vermillion, Nancy; Hightower, Marion Michael

    2014-02-01

    At the request of GDF Suez, a Rough Order of Magnitude (ROM) cost estimate was prepared for the design, construction, testing, and data analysis for an experimental series of large-scale (Liquefied Natural Gas) LNG spills on land and water that would result in the largest pool fires and vapor dispersion events ever conducted. Due to the expected cost of this large, multi-year program, the authors utilized Sandia's structured cost estimating methodology. This methodology insures that the efforts identified can be performed for the cost proposed at a plus or minus 30 percent confidence. The scale of the LNG spill, fire, and vapor dispersion tests proposed by GDF could produce hazard distances and testing safety issues that need to be fully explored. Based on our evaluations, Sandia can utilize much of our existing fire testing infrastructure for the large fire tests and some small dispersion tests (with some modifications) in Albuquerque, but we propose to develop a new dispersion testing site at our remote test area in Nevada because of the large hazard distances. While this might impact some testing logistics, the safety aspects warrant this approach. In addition, we have included a proposal to study cryogenic liquid spills on water and subsequent vaporization in the presence of waves. Sandia is working with DOE on applications that provide infrastructure pertinent to wave production. We present an approach to conduct repeatable wave/spill interaction testing that could utilize such infrastructure.

  1. Proposed equation of state experimental program at NOVA/NIF

    International Nuclear Information System (INIS)

    Holmes, N.C.; Cauble, R.; Celliers, P.; Collins, G.; DaSilva, L.; Hammel, B.; Stewart, R.; Strand, O.; Sullivan, A.

    1996-03-01

    The high pressure equations of state of materials must be accurately known for confident design, simulation, and interpretation of ICF target experiments and for weapons. Here, the authors sketch out a program to perform precise and accurate equation of state (EOS) experiments using large, high-power lasers. The program is divided into three phases: (1) a driver qualification program which will determine the necessary drive and target design parameters; (2) characterization of low and high-Z standard materials; (3) accurate impedance-match experiments to determine equations of state of materials of interest relative to the qualified standards. Novel methods are proposed for the first phase which are an order of magnitude more sensitive than those applied previously. They identify and describe the choices for standards and the samples slated for initial studies. In all cases, their goal is to obtain data that is of sufficiently high quality to serve for design purposes and to validate theories of material response at high pressures of the order of 1--10 TPa. This is particularly important right now, for materials such as CH plastics and hydrogen (DT). In addition, they will suggest a program for EOS measurements for P > 10 TPa, the region of maximum theoretical EOS uncertainty for many materials

  2. Real-time object-oriented programming: studies and proposals

    International Nuclear Information System (INIS)

    Fouquier, Gilles

    1996-01-01

    This thesis contributes to the introduction of real-time features in object-oriented programming. Object-oriented programming favours modularity and reusability. Therefore, its application to real-time introduces many theoretical and conceptual problems. To deal with these problems, a new real-time object-oriented programming model is presented. This model is based on the active object model which allows concurrence and maintains the encapsulation property. The real-time aspect is treated by replacing the concept of task by the concept of method processing and by associating a real-time constraint to each message (priority or deadline). The set of all the running methods is scheduled. This model, called ATOME, contains several sub-models to deal with the usual concurrence control integrating their priority and deadline processing. The classical HPF and EDF scheduling avoid priority or deadline inversion. This model and its variants are new proposals to program real-time applications in the object-oriented way, therefore easing reusability and code writing. The feasibility of this approach is demonstrated by extending and existing active object-based language to real-time, in using the rules defined in the ATOME model. (author) [fr

  3. Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

    Science.gov (United States)

    2014-09-04

    This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

  4. Medicare and Medicaid fraud and abuse regulations.

    Science.gov (United States)

    Liang, F Z; Black, B L

    1991-11-01

    Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.

  5. Medicare Data to Calculate Your Primary Service Areas

    Data.gov (United States)

    U.S. Department of Health & Human Services — The following data is being made available to applicants to the Medicare Shared Savings Program (Shared Savings Program), in order to allow them to calculate their...

  6. Medicare Enrollment Dashboard

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Office of Enterprise Data and Analytics has developed a new interactive Medicare Enrollment Dashboard, which provides current information on the number of...

  7. Medicare Hospice Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — More Medicare beneficiaries are taking advantage of the quality and compassionate care provided through the hospice benefit. As greater numbers of beneficiaries have...

  8. Mapping Medicare Disparities Tool

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Office of Minority Health has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of...

  9. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Issues Stop Overregulating My OR EHR Incentive Program Global Codes and Data Collection New Medicare Card Project Medicare Enrollment and Participation Medicare Payment Rules Physician Quality Reporting System (PQRS) Value-Based Payment Modifier Third Party ...

  10. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.

    Science.gov (United States)

    Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

    2017-06-01

    With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. 77 FR 63537 - Greenhouse Gas Reporting Program: Proposed Amendments and Confidentiality Determinations for...

    Science.gov (United States)

    2012-10-16

    ... Greenhouse Gas Reporting Program: Proposed Amendments and Confidentiality Determinations for Subpart I...-AR61 Greenhouse Gas Reporting Program: Proposed Amendments and Confidentiality Determinations for... Manufacturing, of the Greenhouse Gas Reporting Rule. Proposed changes include revising certain calculation...

  12. 76 FR 40497 - Medicare Program; Changes to the End-Stage Renal Disease Prospective Payment System for CY 2012...

    Science.gov (United States)

    2011-07-08

    ... problems accessing any of the Addenda to the proposed and final rules that are posted on the CMS Web site.... Statement of Need 3. Overall Impact B. Detailed Economic Analysis 1. CY 2012 End-Stage Renal Disease... transition) period during which ESRD facilities receive a blend of payments under the prior basic case-mix...

  13. 78 FR 6272 - Rules Relating to Additional Medicare Tax; Correction

    Science.gov (United States)

    2013-01-30

    ... Rules Relating to Additional Medicare Tax; Correction AGENCY: Internal Revenue Service (IRS), Treasury... regulations are relating to Additional Hospital Insurance Tax on income above threshold amounts (``Additional Medicare Tax''), as added by the Affordable Care Act. Specifically, these proposed regulations provide...

  14. 77 FR 33547 - Privacy Act of 1974, as Amended; Computer Matching Program (SSA/Centers for Medicare and Medicaid...

    Science.gov (United States)

    2012-06-06

    ...: Social Security Administration (SSA). ACTION: Notice of a new computer matching program that will expire... protections for such persons. The Privacy Act, as amended, regulates the use of computer matching by Federal... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA 2012-0015] Privacy Act of 1974, as Amended...

  15. 76 FR 42771 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Science.gov (United States)

    2011-07-19

    ... Payment Window. Pam West, (410) 786-2302, for issues related to the technical corrections. Rebecca Cole or... artery bypass graft CAD--Coronary artery disease CAH--Critical Access Hospital CAHEA--Committee on Allied... Program CBSA--Core-Based Statistical Area CDC--Centers for Disease Control and Prevention CEM--Cardiac...

  16. R and D Proposal for the National Muon Acccelerator Program

    International Nuclear Information System (INIS)

    2010-01-01

    This document contains a description of a multi-year national R and D program aimed at completing a Design Feasibility Study (DFS) for a Muon Collider and, with international participation, a Reference Design Report (RDR) for a muon-based Neutrino Factory. It also includes the supporting component development and experimental efforts that will inform the design studies and permit an initial down-selection of candidate technologies for the ionization cooling and acceleration systems. We intend to carry out this plan with participants from the host national laboratory (Fermilab), those from collaborating U.S. national laboratories (ANL, BNL, Jlab, LBNL, and SNAL), and those from a number of other U.S. laboratories, universities, and SBIR companies. The R and D program that we propose will provide the HEP community with detailed information on future facilities based on intense beams of muons - the Muon Collider and the Neutrino Factory. We believe that these facilities offer the promise of extraordinary physics capabilities. The Muon Collider presents a powerful option to explore the energy frontier and the Neutrino Factory gives the opportunity to perform the most sensitive neutrino oscillation experiments possible, while also opening expanded avenues for the study of new physics in the neutrino sector. The synergy between the two facilities presents the opportunity for an extremely broad physics program and a unique pathway in accelerator facilities. Our work will give clear answers to the questions of expected capabilities and performance of these muon-based facilities, and will provide defensible ranges for their cost. This information, together with the physics insights gained from the next-generation neutrino and LHC experiments, will allow the HEP community to make well-informed decisions regarding the optimal choice of new facilities. We believe that this work is a critical part of any broad strategic program in accelerator R and D and, as the P5 panel has

  17. R&D Proposal for the National Muon Acccelerator Program

    Energy Technology Data Exchange (ETDEWEB)

    2010-02-01

    This document contains a description of a multi-year national R&D program aimed at completing a Design Feasibility Study (DFS) for a Muon Collider and, with international participation, a Reference Design Report (RDR) for a muon-based Neutrino Factory. It also includes the supporting component development and experimental efforts that will inform the design studies and permit an initial down-selection of candidate technologies for the ionization cooling and acceleration systems. We intend to carry out this plan with participants from the host national laboratory (Fermilab), those from collaborating U.S. national laboratories (ANL, BNL, Jlab, LBNL, and SNAL), and those from a number of other U.S. laboratories, universities, and SBIR companies. The R&D program that we propose will provide the HEP community with detailed information on future facilities based on intense beams of muons - the Muon Collider and the Neutrino Factory. We believe that these facilities offer the promise of extraordinary physics capabilities. The Muon Collider presents a powerful option to explore the energy frontier and the Neutrino Factory gives the opportunity to perform the most sensitive neutrino oscillation experiments possible, while also opening expanded avenues for the study of new physics in the neutrino sector. The synergy between the two facilities presents the opportunity for an extremely broad physics program and a unique pathway in accelerator facilities. Our work will give clear answers to the questions of expected capabilities and performance of these muon-based facilities, and will provide defensible ranges for their cost. This information, together with the physics insights gained from the next-generation neutrino and LHC experiments, will allow the HEP community to make well-informed decisions regarding the optimal choice of new facilities. We believe that this work is a critical part of any broad strategic program in accelerator R&D and, as the P5 panel has recently

  18. R&D PROPOSAL FOR THE NATIONAL MUON ACCELERATOR PROGRAM

    Energy Technology Data Exchange (ETDEWEB)

    Muon Accelerator Program; Zisman, Michael S.; Geer, Stephen

    2010-02-24

    This document contains a description of a multi-year national R&D program aimed at completing a Design Feasibility Study (DFS) for a Muon Collider and, with international participation, a Reference Design Report (RDR) for a muon-based Neutrino Factory. It also includes the supporting component development and experimental efforts that will inform the design studies and permit an initial down-selection of candidate technologies for the ionization cooling and acceleration systems. We intend to carry out this plan with participants from the host national laboratory (Fermilab), those from collaborating U.S. national laboratories (ANL, BNL, Jlab, LBNL, and SNAL), and those from a number of other U.S. laboratories, universities, and SBIR companies. The R&D program that we propose will provide the HEP community with detailed information on future facilities based on intense beams of muons--the Muon Collider and the Neutrino Factory. We believe that these facilities offer the promise of extraordinary physics capabilities. The Muon Collider presents a powerful option to explore the energy frontier and the Neutrino Factory gives the opportunity to perform the most sensitive neutrino oscillation experiments possible, while also opening expanded avenues for the study of new physics in the neutrino sector. The synergy between the two facilities presents the opportunity for an extremely broad physics program and a unique pathway in accelerator facilities. Our work will give clear answers to the questions of expected capabilities and performance of these muon-based facilities, and will provide defensible ranges for their cost. This information, together with the physics insights gained from the next-generation neutrino and LHC experiments, will allow the HEP community to make well-informed decisions regarding the optimal choice of new facilities. We believe that this work is a critical part of any broad strategic program in accelerator R&D and, as the P5 panel has recently

  19. Comments on proposed legislation to restructure DOE's uranium enrichment program

    International Nuclear Information System (INIS)

    1991-04-01

    This book focuses on H.R.145, H.R.788, and S.210. Each of the proposed bills would restructure DOE's enrichment program as a government corporation with private financing and would encourage the eventual sale of the corporation to the private sector. In doing so, the bills would, among other things, allow the corporation to set prices to maximize long-term returns; establish a fund to meet the costs of decontamination, decommissioning, and other environmental cleanup costs associated with uranium enrichment activities; transfer interest in DOE's new atomic vapor laser isotope separation (AVLIS) process to the new corporation; and, except for H.R. 145, require the government to pay its share of the costs to clean up mill tailings (mining wastes) generated under government contracts

  20. 42 CFR 403.206 - General standards for Medicare supplemental policies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false General standards for Medicare supplemental policies. 403.206 Section 403.206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Medicare Supplemental Policies...

  1. Programming in a proposed 9X distributed Ada

    Science.gov (United States)

    Waldrop, Raymond S.; Volz, Richard A.; Goldsack, Stephen J.; Holzbach-Valero, A. A.

    1991-01-01

    The studies of the proposed Ada 9X constructs for distribution, now referred to as AdaPT are reported. The goals for this time period were to revise the chosen example scenario and to begin studying about how the proposed constructs might be implemented. The example scenario chosen is the Submarine Combat Information Center (CIC) developed by IBM for the Navy. The specification provided by IBM was preliminary and had several deficiencies. To address these problems, some changes to the scenario specification were made. Some of the more important changes include: (1) addition of a system database management function; (2) addition of a fourth processing unit to the standard resources; (3) addition of an operator console interface function; and (4) removal of the time synchronization function. To implement the CIC scenario in AdaPT, the decided strategy were publics, partitions, and nodes. The principle purpose for implementing the CIC scenario was to demonstrate how the AdaPT constructs interact with the program structure. While considering ways that the AdaPt constructs might be translated to Ada 83, it was observed that the partition construct could reasonably be modeled as an abstract data type. Although this gives a useful method of modeling partitions, it does not at all address the configuration aspects on the node construct.

  2. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    Science.gov (United States)

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  3. Medicare Hospital Spending Per Patient - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  4. Medicare Hospital Spending Per Patient - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  5. Medicare Hospital Spending Per Patient - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  6. Technical Proposal Salton Sea Geothermal Power Pilot Plant Program

    Energy Technology Data Exchange (ETDEWEB)

    None

    1975-03-28

    The proposed Salton Sea Geothermal Power Pilot Plant Program comprises two phases. The objective of Phase 1 is to develop the technology for power generation from high-temperature, high-salinity geothermal brines existing in the Salton Sea known geothermal resources area. Phase 1 work will result in the following: (a) Completion of a preliminary design and cost estimate for a pilot geothermal brine utilization facility. (b) Design and construction of an Area Resource Test Facility (ARTF) in which developmental geothermal utilization concepts can be tested and evaluated. Program efforts will be divided into four sub-programs; Power Generation, Mineral Extraction, Reservoir Production, and the Area Resources Test Facility. The Power Generation Subprogram will include testing of scale and corrosion control methods, and critical power cycle components; power cycle selection based on an optimization of technical, environmental and economic analyses of candidate cycles; preliminary design of a pilot geothermal-electric generating station to be constructed in Phase 2 of this program. The Mineral Extraction Subprogram will involve the following: selection of an optimum mineral recovery process; recommendation of a brine clean-up process for well injection enhancement; engineering, construction and operation of mineral recovery and brine clean-up facilities; analysis of facility operating results from environmental, economical and technical point-of-view; preliminary design of mineral recovery and brine clean-up facilities of sufficient size to match the planned pilot power plant. The Reservoir Production Subprogram will include monitoring the operation and maintenance of brine production, handling and injection systems which were built with private funding in phase 0, and monitoring of the brine characteristics and potential subsidence effects during well production and injection. Based on the above, recommendations and specifications will be prepared for production and

  7. R and D PROPOSAL FOR THE NATIONAL MUON ACCELERATOR PROGRAM

    International Nuclear Information System (INIS)

    Zisman, Michael S.; Geer, Stephen

    2010-01-01

    This document contains a description of a multi-year national R and amp;D program aimed at completing a Design Feasibility Study (DFS) for a Muon Collider and, with international participation, a Reference Design Report (RDR) for a muon-based Neutrino Factory. It also includes the supporting component development and experimental efforts that will inform the design studies and permit an initial down-selection of candidate technologies for the ionization cooling and acceleration systems. We intend to carry out this plan with participants from the host national laboratory (Fermilab), those from collaborating U.S. national laboratories (ANL, BNL, Jlab, LBNL, and SNAL), and those from a number of other U.S. laboratories, universities, and SBIR companies. The R and D program that we propose will provide the HEP community with detailed information on future facilities based on intense beams of muons--the Muon Collider and the Neutrino Factory. We believe that these facilities offer the promise of extraordinary physics capabilities. The Muon Collider presents a powerful option to explore the energy frontier and the Neutrino Factory gives the opportunity to perform the most sensitive neutrino oscillation experiments possible, while also opening expanded avenues for the study of new physics in the neutrino sector. The synergy between the two facilities presents the opportunity for an extremely broad physics program and a unique pathway in accelerator facilities. Our work will give clear answers to the questions of expected capabilities and performance of these muon-based facilities, and will provide defensible ranges for their cost. This information, together with the physics insights gained from the next-generation neutrino and LHC experiments, will allow the HEP community to make well-informed decisions regarding the optimal choice of new facilities. We believe that this work is a critical part of any broad strategic program in accelerator R and D and, as the P5 panel has

  8. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    Science.gov (United States)

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  9. 30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program?

    Science.gov (United States)

    Brandao, Luis Felipe; Zargar, Homayoun; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Ko, Oliver; Samarasekera, Dinesh; Li, Jianbo; Rabets, John; Krishnan, Jayram; Haber, Georges-Pascal; Kaouk, Jihad; Stein, Robert J

    2014-09-01

    After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates. We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy. From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher. Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Disease prevention policy under Medicare: a historical and political analysis.

    Science.gov (United States)

    Schauffler, H H

    1993-01-01

    I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force (pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect the bias of the biomedical model toward screening and immunizations. Counseling services have received the least legislative attention. Factors associated with successful enactment include single-benefit bills, incorporation into budget-deficit reduction legislation, documented evidence of cost-effectiveness, public hearings, sponsorship by chairs of key congressional committees, and persistent congressional leadership. Factors associated with failure include lack of support from Medicare beneficiaries, lack of professional support, impact on total Medicare expenditures, disagreement over or failure to address payment and financing mechanisms, and competing congressional priorities.

  11. Medicare Utilization for Part B

    Data.gov (United States)

    U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part B (Supplementary Medical Insurance SMI) which includes the Medicare Part B Physician and Supplier...

  12. Medicare and Medicaid Linked Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) has been developed to allow for the examination of all Medicare and Medicaid enrollment and...

  13. Medicare Utilization for Part A

    Data.gov (United States)

    U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part A (Hospital Insurance HI) which include the Medicare Ranking for all Short-Stay Hospitals by...

  14. Medicare Administrative Contractor Performance Evaluation

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has compiled a summary of overall Medicare Administrative Contractor (MAC) performance information as measured...

  15. Medicare and Medicaid Research Review

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS), Office of Information Products and Data Analysis (OIPDA), is pleased to present our journal, Medicare and...

  16. Medicare, physicians, and patients.

    Science.gov (United States)

    Hacker, Joseph F

    2004-05-01

    There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit www.ama-assn.org. The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.

  17. 75 FR 56946 - Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

    Science.gov (United States)

    2010-09-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 431 [CMS-2325-P] RIN 0938-AQ46 Medicaid Program; Review and Approval Process for Section 1115 Demonstrations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This...

  18. 78 FR 28551 - Medicaid Program; State Disproportionate Share Hospital Allotment Reductions

    Science.gov (United States)

    2013-05-15

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 447 [CMS-2367-P] RIN 0938-AR31 Medicaid Program; State Disproportionate Share Hospital Allotment Reductions AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: The statute...

  19. Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare.

    Science.gov (United States)

    Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D

    2011-10-14

    Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.

  20. Changes in initial expenditures for benign prostatic hyperplasia evaluation in the Medicare population: a comparison to overall Medicare inflation.

    Science.gov (United States)

    Bellinger, Adam S; Elliott, Sean P; Yang, Liu; Wei, John T; Saigal, Christopher S; Smith, Alexandria; Wilt, Timothy J; Strope, Seth A

    2012-05-01

    Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. The United States foreign research reactor spent nuclear fuel acceptance program: Proposal to modify the program

    International Nuclear Information System (INIS)

    Messick, C.E.

    2005-01-01

    The United States Department of Energy (DOE), in consultation with the Department of State (DOS), adopted the Nuclear Weapons Nonproliferation Policy Concerning Foreign Research Reactor Spent Nuclear Fuel in May 1996. The policy was slated to expire in May 2009. However, in October 2003, a petition requesting a program extension was delivered to the United States Secretary of Energy from a group of research reactor operators from foreign countries. In April 2004, the Secretary directed DOE undertake an analysis, as required by the National Environmental Policy Act (NEPA), to consider potential extension of the Program. On December 1, 2004, a Federal Register Notice was issued approving the program extension. This paper discusses the findings from the NEPA analysis and the potential changes in the program that may result from implementation of the proposed changes. (author)

  2. Applying the 2003 Beers Update to Elderly Medicare Enr...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Applying the 2003 Beers Update to Elderly Medicare Enrollees in the Part D Program Inappropriate prescribing of certain medications known as Beers drugs may be...

  3. Vertical integration strategies: revenue effects in hospital and Medicare markets.

    Science.gov (United States)

    Cody, M

    1996-01-01

    The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.

  4. MEDICARE: Improvements Needed in Provider Communications and Contracting Procedures

    National Research Council Canada - National Science Library

    Aronovitz, Leslie

    2001-01-01

    .... Under Medicare's fee-for-service system-which accounts for over 80 percent of program beneficiaries physicians, hospitals, and other providers submit claims to receive reimbursement for services...

  5. Medicare Advantage Plans

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  6. Your Medicare Rights

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  7. What Is Medicare?

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  8. What Medicare Covers

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  9. Claims and Appeals (Medicare)

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  10. 75 FR 71513 - Senior Community Service Employment Program; Notice of Proposed Rulemaking, Additional Indicator...

    Science.gov (United States)

    2010-11-23

    ... additional performance indicator for volunteer work. The Proposed Rule adds a new additional indicator to... Program; Notice of Proposed Rulemaking, Additional Indicator on Volunteer Work; Proposed Rule #0;#0... work in the Senior Community Service Employment Program (SCSEP). Specifically, this rule proposes to...

  11. 75 FR 60398 - California: Proposed Authorization of State Hazardous Waste Management Program Revision

    Science.gov (United States)

    2010-09-30

    ...: Proposed Authorization of State Hazardous Waste Management Program Revision AGENCY: Environmental... its hazardous waste management program by November 1, 2010. ADDRESSES: Submit your comments... waste management program. EPA continues to have independent enforcement authority under RCRA sections...

  12. A Proposal to Build an Education Research and Development Program: The Kamehameha Early Education Project Proposal. Technical Report #3.

    Science.gov (United States)

    Gallimore, Ronald; And Others

    This report summarizes the programmatic features of a proposal for the Kamehameha Early Education Project (KEEP), a program aimed at the development, demonstration, and dissemination of methods for improving the education of Hawaiian and part-Hawaiian children. A brief description of the proposed project goals, structure, organization, and…

  13. New options to integrate care and financing for persons dually eligible for Medicare and Medicaid.

    Science.gov (United States)

    Hayes, Katherine Jett; Thorpe, Jane Hyatt

    2012-01-01

    This paper reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and discusses several new models available for consideration by federal and state policymakers. These options draw on experience from existing programs and waivers to provide suggested changes to existing programs, as well as a permanent state plan option for a fully integrated, capitated care model. This model could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.

  14. PROGRESSIVE CHOICE PROGRAMMING FOR DELINQUENOGENIC COMMUNITIES, A PROPOSAL FOR RESEARCH.

    Science.gov (United States)

    Institute of Educational Research, Washington, DC.

    THE TWO MAJOR TARGET POPULATIONS FOR THESE PROGRAMS ARE CHILDREN ENTERING SCHOOL IN FIRST OR SECOND GRADE WHO ARE IN DELINQUENOGENIC NEIGHBORHOODS AND ADOLESCENT DROPOUTS WHO ATTEND SPECIAL YOUTH COUNSELING CENTERS WHERE SKILLS CAN BE TAUGHT. THE PROGRAM SHOULD DEVELOP READING SKILLS AND ENRICH VOCABULARY PROVIDING A BASIS FOR ACCELERATED…

  15. Medicare hospital spending per patient (Medicare Spending per Beneficiary) – Additional Decimal Places

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  16. Professional skills training proposal for professors of health programs

    Directory of Open Access Journals (Sweden)

    Mauricio Alberto Ángel-Macías

    2017-10-01

    Conclusions: This study shows the urgent need for creating training spaces in pedagogy, didactics and evaluation. In consequence, a model that includes cognitive, methodological, social and personal skills is proposed.

  17. Medicare program; payment policies under the physician fee schedule, five-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to part B for CY 2012. Final rule with comment period.

    Science.gov (United States)

    2011-11-28

    This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

  18. 77 FR 9216 - Native American Career and Technical Education Program; Proposed Waivers and Extension of the...

    Science.gov (United States)

    2012-02-16

    ... DEPARTMENT OF EDUCATION Native American Career and Technical Education Program; Proposed Waivers...) 2007 under the Native American Career and Technical Education Program (NACTEP), the Secretary proposes... secondary school career and technical education programs. \\1\\ Section 116(a)(2) of the Carl D. Perkins...

  19. 78 FR 23775 - Notice of Proposed Information Collection; Comment Request: Tax Credit Assistance Program (TCAP)

    Science.gov (United States)

    2013-04-22

    ... Information Collection; Comment Request: Tax Credit Assistance Program (TCAP) AGENCY: Office of the Chief... information: Title of Proposed: Tax Credit Assistance Program (TCAP). OMB Approval Number: 2506-0181. Form Numbers: None. Description of the need for the information and proposed use: Tax Credit Assistance Program...

  20. Predictors of regional Medicare expenditures for otolaryngology physician services.

    Science.gov (United States)

    Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N

    2017-06-01

    To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society

  1. Disease management for chronically ill beneficiaries in traditional Medicare.

    Science.gov (United States)

    Bott, David M; Kapp, Mary C; Johnson, Lorraine B; Magno, Linda M

    2009-01-01

    We summarize the Centers for Medicare and Medicaid Services' (CMS's) experience with disease management (DM) in fee-for-service Medicare. Since 1999, the CMS has conducted seven DM demonstrations involving some 300,000 beneficiaries in thirty-five programs. Programs include provider-based, third-party, and hybrid models. Reducing costs sufficient to cover program fees has proved particularly challenging. Final evaluations on twenty programs found three with evidence of quality improvement at or near budget-neutrality, net of fees. Interim monitoring covering at least twenty-one months on the remaining fifteen programs suggests that four are close to covering their fees. Characteristics of the traditional Medicare program present a challenge to these DM models.

  2. 75 FR 18873 - Notice of Proposed Information Collection: Youthbuild Program

    Science.gov (United States)

    2010-04-13

    .... The Youthbuild grant life cycle is approximately 30 months with approximately 86 currently active... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5377-N-01] Notice of Proposed... be sent to: Robert Duncan, Department of Housing Urban and Development, 451 7th Street, SW., Room...

  3. Examining Measures of Income and Poverty in Medicare Administrative Data.

    Science.gov (United States)

    Samson, Lok Wong; Finegold, Kenneth; Ahmed, Azeem; Jensen, Matthew; Filice, Clara E; Joynt, Karen E

    2017-12-01

    Disparities by economic status are observed in the health status and health outcomes of Medicare beneficiaries. For health services and health policy researchers, one barrier to addressing these disparities is the ability to use Medicare data to ascertain information about an individual's income level or poverty, because Medicare administrative data contains limited information about individual economic status. Information gleaned from other sources-such as the Medicaid and Supplemental Security Income programs-can be used in some cases to approximate the income of Medicare beneficiaries. However, such information is limited in its availability and applicability to all beneficiaries. Neighborhood-level measures of income can be used to infer individual-level income, but level of neighborhood aggregation impacts accuracy and usability of the data. Community-level composite measures of economic status have been shown to be associated with health and health outcomes of Medicare beneficiaries and may capture neighborhood effects that are separate from individual effects, but are not readily available in Medicare data and do not serve to replace information about individual economic status. There is no single best method of obtaining income data from Medicare files, but understanding strengths and limitations of different approaches to identifying economic status will help researchers choose the best method for their particular purpose, and help policymakers interpret studies using measures of income.

  4. 77 FR 24766 - Call for Proposals for a Micro Support Program on International Conflict Resolution and...

    Science.gov (United States)

    2012-04-25

    ... UNITED STATES INSTITUTE OF PEACE Call for Proposals for a Micro Support Program on International Conflict Resolution and Peacebuilding For Immediate Release AGENCY: United States Institute of Peace. ACTION: Notice. SUMMARY: Micro Support Program on International Conflict Resolution and Peacebuilding...

  5. 76 FR 38198 - Notice of Submission of Proposed Information Collection to OMB Housing Counseling Program...

    Science.gov (United States)

    2011-06-29

    ... Proposed Information Collection to OMB Housing Counseling Program- Application for Approval as a Housing... private nonprofit agencies that provide housing counseling services directly or through their affiliates or branches regarding home buying, homeownership and rental housing programs submit an application...

  6. 77 FR 17458 - Proposed Information Collection; Comment Request; Observer Programs' Information that Can Be...

    Science.gov (United States)

    2012-03-26

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Proposed Information Collection; Comment Request; Observer Programs' Information that Can Be Gathered Only Through Questions... options; and (5) ensure that the observer programs can safely and efficiently collect the information...

  7. 75 FR 36659 - Proposed Collection; Comment Request; Brain Power! The NIDA Junior Scientist Program and the...

    Science.gov (United States)

    2010-06-28

    ... of the Brain Power! Program's ability to: Increase students' knowledge about the biology of the brain... Request; Brain Power! The NIDA Junior Scientist Program and the Companion Program, Brain Power! Challenge.... Proposed Collection: Title: Brain Power! The NIDA Junior Scientist Program, for grades K-5, and the...

  8. 76 FR 18570 - Notice of Proposed Information Collection for Public Comment; HOPE VI Public Housing Programs...

    Science.gov (United States)

    2011-04-04

    ... Information Collection for Public Comment; HOPE VI Public Housing Programs: Funding and Program Data... responses. This Notice also lists the following information: Title of Proposal: HOPE VI program. OMB Control... (Pub. L. 105- 276, 112 Stat. 2461, approved October 21, 1998) and revised by the HOPE VI Program...

  9. Medicare Managed Care plan Performance, A Comparison...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...

  10. R&D PROPOSAL FOR THE NATIONAL MUON ACCELERATOR PROGRAM

    OpenAIRE

    Zisman, Michael S.

    2011-01-01

    This document contains a description of a multi-year national R&D program aimed at completing a Design Feasibility Study (DFS) for a Muon Collider and, with international participation, a Reference Design Report (RDR) for a muon-based Neutrino Factory. It also includes the supporting component development and experimental efforts that will inform the design studies and permit an initial down-selection of candidate technologies for the ionization cooling and acceleration systems. We intend to ...

  11. Validation of a proposal for evaluating hospital infection control programs.

    Science.gov (United States)

    Silva, Cristiane Pavanello Rodrigues; Lacerda, Rúbia Aparecida

    2011-02-01

    To validate the construct and discriminant properties of a hospital infection prevention and control program. The program consisted of four indicators: technical-operational structure; operational prevention and control guidelines; epidemiological surveillance system; and prevention and control activities. These indicators, with previously validated content, were applied to 50 healthcare institutions in the city of São Paulo, Southeastern Brazil, in 2009. Descriptive statistics were used to characterize the hospitals and indicator scores, and Cronbach's α coefficient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certification. The construct validity analysis was based on exploratory factor analysis with a tetrachoric correlation matrix. The indicators for the technical-operational structure and epidemiological surveillance presented almost 100% conformity in the whole sample. The indicators for the operational prevention and control guidelines and the prevention and control activities presented internal consistency ranging from 0.67 to 0.80. The discriminant validity of these indicators indicated higher and statistically significant mean conformity scores among the group of institutions with healthcare certification or accreditation processes. In the construct validation, two dimensions were identified for the operational prevention and control guidelines: recommendations for preventing hospital infection and recommendations for standardizing prophylaxis procedures, with good correlation between the analysis units that formed the guidelines. The same was found for the prevention and control activities: interfaces with treatment units and support units were identified. Validation of the measurement properties of the hospital infection prevention and control program indicators made it possible to develop a tool for evaluating these programs

  12. Preliminary proposal for a beryllium technology program for fusion applications

    International Nuclear Information System (INIS)

    1985-02-01

    The program was designed to provide the answers to the critical issues of beryllium technology needed in fusion blanket designs. The four tasks are as follows: (1) Beryllium property measurements needed for fusion data base. (2) Beryllium stress relaxation and creep measurements for lifetime modelling calculations. (3) Simplified recycle technique development for irradiated beryllium. (4) Beryllium neutron multiplier measurements using manganese bath absolute calibration techniques

  13. A Proposal for the Common Safety Approach of Space Programs

    Science.gov (United States)

    Grimard, Max

    2002-01-01

    For all applications, business and systems related to Space programs, Quality is mandatory and is a key factor for the technical as well as the economical performances. Up to now the differences of applications (launchers, manned space-flight, sciences, telecommunications, Earth observation, planetary exploration, etc.) and the difference of technical culture and background of the leading countries (USA, Russia, Europe) have generally led to different approaches in terms of standards and processes for Quality. At a time where international cooperation is quite usual for the institutional programs and globalization is the key word for the commercial business, it is considered of prime importance to aim at common standards and approaches for Quality in Space Programs. For that reason, the International Academy of Astronautics has set up a Study Group which mandate is to "Make recommendations to improve the Quality, Reliability, Efficiency, and Safety of space programmes, taking into account the overall environment in which they operate : economical constraints, harsh environments, space weather, long life, no maintenance, autonomy, international co-operation, norms and standards, certification." The paper will introduce the activities of this Study Group, describing a first list of topics which should be addressed : Through this paper it is expected to open the discussion to update/enlarge this list of topics and to call for contributors to this Study Group.

  14. Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

    Science.gov (United States)

    2014-11-06

    This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

  15. Technical basis for the proposed high efficiency nuclear fuel program

    International Nuclear Information System (INIS)

    MacDonald, P.E.; Herring, J.S.; Crawford, D.C.; Neimark, L.E.

    1999-01-01

    Greenhouse gas emissions from fossil fired electricity generating stations will dramatically increase over the next 20 years. Nuclear energy is the only fully developed technology able to supply large amounts of electricity without generation of greenhouse gases. However, the problem of noncompetitive economics and public concerns about radioactive waste disposal, safety, and nuclear weapons proliferation may prevent the reemergence of nuclear power as a preferred option for new electric energy generation in the U.S. This paper discusses a new research program to help address these issues, by developing fuel designs capable of burnup values in excess of 60 MWD/kgU. The objectives of the program are to: improve the reliability and robustness of light water reactor fuel, thereby improving safety margins; Significantly increase the energy generated by each fuel loading, thereby achieving longer operating cycles, higher capacity factors, and lower cost electric power; Significantly reduce the volume of spent nuclear fuel discharged for disposal by allowing more energy to be extracted from each fuel element prior to discharge; Develop fuel that is much more proliferation resistant. (author)

  16. Impacts of the proposed program approach on waste stream characteristics

    International Nuclear Information System (INIS)

    King, J.F.; Fleming, M.E.

    1995-01-01

    The evolution of the U.S. Department of Energy's Civilian Radioactive Waste Management System (CRWMS) over the past few years has led to significant changes in key system scenario assumption. This paper describes the effects of two recent changes on waste stream characteristics focusing primarily on repository impacts. First, the multi-purpose canister (MPC) concept has been included in the Program baseline. The change from a bare fuel system to one including an MPC-based system forces the fuel assemblies initially loaded together in MPCs to remain together throughout the system. Second, current system analyses also assume a system without a monitored retrievable storage (MRS), with the understanding that an MRS would be reincorporated if a site becomes available. Together these two changes have significant impacts on waste stream characteristics. Those two changes create a class of scenarios referred to generally as Program Approach (PA) scenarios. Scenarios based on the previously assumed system, bare fuel with an MRS, are referred to here as the Previous Reference (PR) system scenarios. The analysis compares scenarios with otherwise consistent assumptions and presents summary comparisons. The number of disposal containers and the waste heat output are determined for eight PA and PR scenarios

  17. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... My OR EHR Incentive Program Global Codes and Data Collection Patient Opioid Use New Medicare Card Project Medicare ... self-care checklist Evaluation (Complete the Ostomy Patient Survey . We need your opinion!) Program outcomes The ACS ...

  18. Improving the design of competitive bidding in Medicare Advantage.

    Science.gov (United States)

    Cawley, John H; Whitford, Andrew B

    2007-04-01

    In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which required that in 2006 the Centers for Medicare and Medicaid Services (CMS) implement a system of competitive bids to set payments for the Medicare Advantage program. Managed care plans now bid for the right to enroll Medicare beneficiaries. Data from the first year of bidding suggest that imperfect competition is limiting the success of the bidding system. This article offers suggestions to improve this system based on findings from auction theory and previous government-run auctions. In particular, CMS can benefit by adjusting its system of competitive bids in four ways: credibly committing to regulations governing bidding; limiting the scope for collusion, entry deterrence, and predatory behavior among bidders; adjusting how benchmark reimbursement rates are set; and accounting for asymmetric information among bidders.

  19. 77 FR 30305 - Notice of Proposed Information Collection; Comment Request Housing Counseling Program

    Science.gov (United States)

    2012-05-22

    ... Information Collection; Comment Request Housing Counseling Program AGENCY: Office of the Assistant Secretary... information: Title of Proposal: Housing Counseling Program. OMB Control Number, if applicable: 2502-0261. Description of the need for the information and proposed use: Nonprofit Housing Counseling organizations...

  20. Looking at CER from Medicare's perspective.

    Science.gov (United States)

    Mohr, Penny

    2012-05-01

    Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly

  1. Medicare and Medicaid programs; physicians' referrals to health care entities with which they have financial relationships: partial delay of effective date. Interim final rule with comment period; partial delay in effective date.

    Science.gov (United States)

    2001-12-03

    This interim final rule with comment period delays for 1 year the effective date of the last sentence of 42 CFR 411.354(d)(1). Section 411.354(d)(1) was promulgated in the final rule entitled "Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships," published in the Federal Register on January 4, 2001 (66 FR 856). A 1-year delay in the effective date of the last sentence in Section 411.354(d)(1) will give Department officials the opportunity to reconsider the definition of compensation that is "set in advance" as it relates to percentage compensation methodologies in order to avoid unnecessarily disrupting existing contractual arrangements for physician services. Accordingly, the last sentence of Section 411.354(d)(1), which would have become effective January 4, 2002, will not become effective until January 6,2003.

  2. 78 FR 70090 - 30-Day Notice of Proposed Information Collection: PEPFAR Program Expenditures

    Science.gov (United States)

    2013-11-22

    .... Summaries of these data provide key information about program costs under PEPFAR on a global level. Applying... Program Expenditures. OMB Control Number: 1405-0208. Type of Request: Revision of a currently approved... program monitoring, the Finance and Economics Work Group under PEPFAR proposes to add reporting of...

  3. Proposed Accreditation Standards for Degree-Granting Correspondence Programs Offered by Accredited Institutions.

    Science.gov (United States)

    McGraw-Hill Continuing Education Center, Washington, DC.

    A study on proposed accreditation standards grew out of a need to (1) stimulate the growth of quality correspondence degree programs; and (2) provide a policy for accreditation of correspondence degree programs so that graduates would be encouraged to pursue advanced degree programs offered elsewhere by educational institutions. The study focused…

  4. 76 FR 71037 - Proposed National Toxicology Program (NTP) Review Process for the Report on Carcinogens: Request...

    Science.gov (United States)

    2011-11-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Proposed National Toxicology Program (NTP) Review Process...: Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences.... Bucher, Associate Director, National Toxicology Program. [FR Doc. 2011-29615 Filed 11-15-11; 8:45 am...

  5. 77 FR 27253 - Proposed Collection, Laura Bush 21st Century Librarian Grant Program Evaluation

    Science.gov (United States)

    2012-05-09

    ... Century Librarian Grant Program Evaluation AGENCY: Institute of Museum and Library Services, National... evaluate and make improvements to the Laura Bush 21st Century Librarian (LB21) Grant Program. The... proposes clearance of the Laura Bush 21st Century Librarian Grant Program Evaluation. The 60-day Notice for...

  6. Reductions in mortality among Medicare beneficiaries following the implementation of Medicare Part D.

    Science.gov (United States)

    Semilla, April P; Chen, Fang; Dall, Timothy M

    2015-07-01

    Medicare Part D is a prescription drug program that provides seniors and disabled individuals enrolled in Medicare with outpatient drug coverage benefits. Part D has been shown to increase access to medicines and improve medication adherence; however, the effect of Part D on health outcomes has not yet been extensively studied. In this study, we used a published and validated Markov-based microsimulation model to quantify the relationships among medication use, disease incidence and severity, and mortality. Based on the simulation results, we estimate that since the implementation of Part D in 2006, nearly 200,000 Medicare beneficiaries have lived at least 1 year longer. Reductions in mortality have occurred because of fewer deaths associated with medication-sensitive conditions such as diabetes, congestive heart failure, stroke, and myocardial infarction. Improved access to medication through Medicare Part D helps patients improve blood pressure, cholesterol, and blood glucose levels, which in turn can prevent or delay the onset of disease and the incidence of adverse health events, thus reducing mortality.

  7. Center for Medicare & Medicaid Services (CMS) , Medicare Claims data

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2003 forward. CMS compiles claims data for Medicare and Medicaid patients across a variety of categories and years. This includes Inpatient and Outpatient claims,...

  8. Competitive pricing and the challenge of cost control in medicare.

    Science.gov (United States)

    Coulam, Robert F; Feldman, Roger D; Dowd, Bryan E

    2011-08-01

    The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.

  9. Chronic Conditions among Medicare Beneficiaries

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data used in the chronic condition reports are based upon CMS administrative enrollment and claims data for Medicare beneficiaries enrolled in the...

  10. Medicare Referring Provider DMEPOS PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset, which is part of CMSs Medicare Provider Utilization and Payment Data, details information on Durable Medical Equipment, Prosthetics, Orthotics and...

  11. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  12. Medicare and Medicaid Statistical Supplement

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Office of Enterprise Data and Analytics (OEDA) produced an annual Medicare and Medicaid Statistical Supplement report providing detailed statistical...

  13. 76 FR 44306 - Proposed Information Collection; Comment Request; Fisheries Finance Program Requirements

    Science.gov (United States)

    2011-07-25

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Proposed Information Collection; Comment Request; Fisheries Finance Program Requirements AGENCY: National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice. SUMMARY: The Department of Commerce, as part of its continuing...

  14. 75 FR 52393 - Proposed Data Collection; Comment Request: New Markets Tax Credit (NMTC) Program-Allocation...

    Science.gov (United States)

    2010-08-25

    ... DEPARTMENT OF THE TREASURY Community Development Financial Institutions Fund Proposed Data... Institutions (CDFI) Fund, Department of the Treasury, is soliciting comments concerning the New Markets Tax... comments to Rosa Martinez, Acting NMTC Program Manager, Community Development Financial Institutions Fund...

  15. Medicare program; revision to accrual basis of accounting policy. Department of Health and Human Services (HHS), Health Care Financing Administration (HCFA). Final rule.

    Science.gov (United States)

    1999-09-27

    Medicare policy provides that payroll taxes that a provider becomes obligated to remit to governmental agencies are included in allowable costs only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in 1 year but not paid until the next year, the associated payroll taxes are not an allowable cost until the next year. This final rule provides for an exception when payment would be made to the employee in the current year but for the fact that regularly scheduled payment date is after the end of the year. In that case, the rule requires allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this rule is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on end-of-the-year payroll is allowable in the current period rather than in the following period.

  16. Patient-centered care: an opportunity to accomplish the "Three Aims" of the National Quality Strategy in the Medicare ESRD program.

    Science.gov (United States)

    O'Hare, Ann M; Armistead, Nancy; Schrag, Wendy L Funk; Diamond, Louis; Moss, Alvin H

    2014-12-05

    In light of mounting federal government debt and levels of Medicare spending that are widely viewed as unsustainable, commentators have called for a transformation of the United States health care system to deliver better care at lower costs. This article presents the priorities of the Coalition for Supportive Care of Kidney Patients for how clinicians might achieve this transformation for patients with advanced CKD and their families. The authors suspect that much of the high-intensity, high-cost care currently delivered to patients with advanced kidney disease may be unwanted and that the "Three Aims" put forth by the National Quality Strategy of better care for the individual, better health for populations, and reduced health care costs may be within reach for patients with CKD and ESRD. This work describes the coalition's vision for a more patient-centered approach to the care of patients with kidney disease and argues for more concerted efforts to align their treatments with their goals, values, and preferences. Key priorities to achieve this vision include using improved prognostic models and decision science to help patients, their families, and their providers better understand what to expect in the future; engaging patients and their families in shared decision-making before the initiation of dialysis and during the course of dialysis treatment; and tailoring treatment strategies throughout the continuum of their care to address what matters most to individual patients. Copyright © 2014 by the American Society of Nephrology.

  17. Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance.

    Science.gov (United States)

    Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey

    2017-09-01

    (HCPCS code E0143; 95% CI, 66.3%-68.5%) to 75.8% for a complete blood cell count (CPT 85025; 95% CI, 75.0%-76.6%). Traditional Medicare's administratively set rates act as a strong anchor for physician reimbursement in the MA market, although MA plans succeed in negotiating lower prices for other health care services for which TM overpays. Reforms that transition the Medicare program toward some premium support models could substantially affect how physicians and other clinicians are paid.

  18. 42 CFR 403.322 - Termination of agreements for Medicare recognition of State systems.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Termination of agreements for Medicare recognition of State systems. 403.322 Section 403.322 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Recognition of State...

  19. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    Science.gov (United States)

    Davitt, Joan K.

    2014-01-01

    Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

  20. Pilot program to assess proposed basic quality assurance requirements in the medical use of byproduct materials

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan, E.; Nelson, K.; Meinhold, C.B. (Brookhaven National Lab., Upton, NY (United States))

    1991-10-01

    In January 1990, the Nuclear Regulatory Commission (NRC) proposed amendments to 10 CFR Part 35 that would require medical licensees using byproduct material to establish and implement a basic quality assurance program. A 60-day real-world trial of the proposed rules was initiated to obtain information beyond that generally found through standard public comment procedures. Volunteers from randomly selected institutions had opportunities to review the details of the proposed regulations and to implement these rules on a daily basis during the trial. The participating institutions were then asked to evaluate the proposed regulations based on their personal experiences. The pilot project sought to determine whether medical institutions could develop written quality assurance programs that would meet the eight performance-based objectives of proposed Section 35.35. In addition, the NRC wanted to learn from these volunteers if they had any recommendations on how the rule could be revised to minimized its cost and to clarify its objectives without decreasing its effectiveness. It was found that licensees could develop acceptable QA programs under a performance-based approach, that most licensee programs did meet the proposed objectives, and that most written QA plans would require consultations with NRC or Agreement State personnel before they would fully meet all objectives of proposed Section 35.35. This report describes the overall pilot program. The methodology used to select and assemble the group of participating licensees is presented. The various workshops and evaluation questionnaires are discussed, and detailed findings are presented. 7 refs.

  1. Pilot program to assess proposed basic quality assurance requirements in the medical use of byproduct materials

    International Nuclear Information System (INIS)

    Kaplan, E.; Nelson, K.; Meinhold, C.B.

    1991-10-01

    In January 1990, the Nuclear Regulatory Commission (NRC) proposed amendments to 10 CFR Part 35 that would require medical licensees using byproduct material to establish and implement a basic quality assurance program. A 60-day real-world trial of the proposed rules was initiated to obtain information beyond that generally found through standard public comment procedures. Volunteers from randomly selected institutions had opportunities to review the details of the proposed regulations and to implement these rules on a daily basis during the trial. The participating institutions were then asked to evaluate the proposed regulations based on their personal experiences. The pilot project sought to determine whether medical institutions could develop written quality assurance programs that would meet the eight performance-based objectives of proposed Section 35.35. In addition, the NRC wanted to learn from these volunteers if they had any recommendations on how the rule could be revised to minimized its cost and to clarify its objectives without decreasing its effectiveness. It was found that licensees could develop acceptable QA programs under a performance-based approach, that most licensee programs did meet the proposed objectives, and that most written QA plans would require consultations with NRC or Agreement State personnel before they would fully meet all objectives of proposed Section 35.35. This report describes the overall pilot program. The methodology used to select and assemble the group of participating licensees is presented. The various workshops and evaluation questionnaires are discussed, and detailed findings are presented. 7 refs

  2. 78 FR 31999 - 30-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting

    Science.gov (United States)

    2013-05-28

    ... DEPARTMENT OF STATE [Public Notice 8337] 30-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting ACTION: Notice of request for public comment and submission to OMB of proposed collection of information. SUMMARY: The Department of State has submitted the information...

  3. 76 FR 22411 - Notice of Proposed Information Collection: Comment Request; Housing Counseling Program...

    Science.gov (United States)

    2011-04-21

    ... Information Collection: Comment Request; Housing Counseling Program--Application for Approval as a Housing Counseling Agency AGENCY: Office of the Assistant Secretary for Housing, HUD. ACTION: Notice. SUMMARY: The...: Title of Proposal: Housing Counseling Program--Application for Approval as a Housing Counseling Agency...

  4. 77 FR 61776 - Notice of Submission of Proposed Information Collection to OMB Housing Counseling Program

    Science.gov (United States)

    2012-10-11

    ... Proposed Information Collection to OMB Housing Counseling Program AGENCY: Office of the Assistant Secretary... Housing Counseling Program and reference to the NOFA charts were excluded. Nonprofit Housing Counseling... provide housing counseling assistance to eligible homebuyers to find and purchase affordable housing...

  5. 78 FR 12349 - Proposed Information Collection; Land and Water Conservation Fund State Assistance Program

    Science.gov (United States)

    2013-02-22

    ...] Proposed Information Collection; Land and Water Conservation Fund State Assistance Program AGENCY: National.... Abstract The Land and Water Conservation Fund Act of 1965 (LWCF Act) (16 U.S.C. 460l-4 et seq.) was enacted... discussed in detail in the Land and Water Conservation Fund State Assistance Program Federal Financial...

  6. 76 FR 67200 - Proposed National Toxicology Program (NTP) Review Process for the Report on Carcinogens: Request...

    Science.gov (United States)

    2011-10-31

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Proposed National Toxicology... Session AGENCY: Division of the National Toxicology Program (DNTP), National Institute of Environmental.... Bucher, Associate Director, National Toxicology Program. [FR Doc. 2011-28132 Filed 10-28-11; 8:45 am...

  7. Program grants for black lung clinics--PHS. Notice of proposed rulemaking.

    Science.gov (United States)

    1983-11-01

    The Public Health Service proposed to revise the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.

  8. 75 FR 78939 - Senior Community Service Employment Program; Notice of Proposed Rulemaking, Additional Indicator...

    Science.gov (United States)

    2010-12-17

    ... Community Service Employment Program; Notice of Proposed Rulemaking, Additional Indicator on Volunteer Work... Senior Community Service Employment Program (SCSEP), Additional Indicator on Volunteer Work that was... number of exiting participants who enter volunteer work. The relevant Office of Management and Budget...

  9. 77 FR 13619 - Notice of Submission of Proposed Information Collection to OMB; Housing Choice Voucher Program

    Science.gov (United States)

    2012-03-07

    ... Proposed Information Collection to OMB; Housing Choice Voucher Program AGENCY: Office of the Chief... assistance payments, and budget and payment documentation. In some cases, PHAs voluntarily divest their voucher programs to a receiving PHA. PHAs may also project-base a portion of their vouchers or use their...

  10. 75 FR 55596 - Notice of Submission of Proposed Information Collection to OMB Housing Choice Voucher Program

    Science.gov (United States)

    2010-09-13

    ... Proposed Information Collection to OMB Housing Choice Voucher Program AGENCY: Office of the Chief... assistance payments, and budget and payment documentation. In some cases PHAs voluntarily divest their voucher programs to a receiving PHA. PHAs may also project-base a portion of their vouchers or use their...

  11. Doctors as Stewards of medicare, or not: CAMSI, MRG, CDM, DRHC and the thin alphabet soup of physician support.

    Science.gov (United States)

    Duffin, Jacalyn

    2018-07-01

    Physicians are deeply involved in Canadian medicare because it is through medicare that they are paid. However, from its origins to the present physicians -as a profession - have not been strong supporters of medicare. Fearing loss of income and individual autonomy, they have frequently opposed it with criticisms, strikes, threatened job action and lawsuits. Some opponents are unaware that medicare was a boon to physician income, and many fail to connect medicare with responsibility for improving the health status of the country. This paper will trace physician involvement, support and opposition to medicare from its inception to the present, with special attention to small physician organizations that have supported medicare. It will close with a proposal for how doctors could display greater stewardship.

  12. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... QPP Resource Center 2018 Information 2017 Information Program Rules Surgeon Specific Registry Metabolic and Bariatric Surgery Accreditation ... Card Project Medicare Enrollment and Participation Medicare Payment Rules Physician Quality Reporting System (PQRS) Value-Based Payment ...

  13. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... OR EHR Incentive Program Global Codes and Data Collection Patient Opioid Use New Medicare Card Project Medicare ... History History of the American College of Surgeons Collections Highlights Research 25- and 50-Year Fellows Recognition ...

  14. Paying Medicare Advantage plans: To level or tilt the playing field.

    Science.gov (United States)

    Glazer, Jacob; McGuire, Thomas G

    2017-12-01

    Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and subsidizes MA plans based on a "benchmark" for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Many analysts recommend equalizing Medicare's subsidy across the options - referred to in policy circles as a "level playing field." This paper studies the normative question of how to set the level of the benchmark, applying the versatile model developed by Einav and Finkelstein (EF) to Medicare. The EF framework implies unequal subsidies to counteract risk selection across plan types. We also study other reasons to tilt the field: the relative efficiency of MA vs. TM, market power of MA plans, and institutional features of the way Medicare determines subsidies and premiums. After review of the empirical and policy literature, we conclude that in areas where the MA market is competitive, the benchmark should be set below average costs in TM, but in areas characterized by imperfect competition in MA, it should be raised in order to offset output (enrollment) restrictions by plans with market power. We also recommend specific modifications of Medicare rules to make demand for MA more price elastic. Copyright © 2016. Published by Elsevier B.V.

  15. Controlling prescription drug costs: regulation and the role of interest groups in Medicare and the Veterans Health Administration.

    Science.gov (United States)

    Frakt, Austin B; Pizer, Steven D; Hendricks, Ann M

    2008-12-01

    Medicare and the Veterans Health Administration (VA) both finance large outpatient prescription drug programs, though in very different ways. In the ongoing debate on how to control Medicare spending, some suggest that Medicare should negotiate directly with drug manufacturers, as the VA does. In this article we relate the role of interest groups to policy differences between Medicare and the VA and, in doing so, explain why such a large change to the Medicare drug program is unlikely. We argue that key policy differences are attributable to stable differences in interest group involvement. While this stability makes major changes in Medicare unlikely, it suggests the possibility of leveraging VA drug purchasing to achieve savings in Medicare. This could be done through a VA-administered drug-only benefit for Medicare-enrolled veterans. Such a partnership could incorporate key elements of both programs: capacity to accept large numbers of enrollees (like Medicare) and leverage to negotiate prescription drug prices (like the VA). Moreover, it could be implemented at no cost to the VA while achieving savings for Medicare and beneficiaries.

  16. Cataract surgery among Medicare beneficiaries.

    Science.gov (United States)

    Schein, Oliver D; Cassard, Sandra D; Tielsch, James M; Gower, Emily W

    2012-10-01

    To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, sex, race and state; surgical volume by facility type and surgeon characteristics; time interval between first- and second-eye cataract surgery. The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those aged 75-84 years. After adjustment for age and sex, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, sex, age, and by certain provider characteristics.

  17. Striking a Balance between Program Requirements and GT Principles: Writing a compromised GT proposal

    Directory of Open Access Journals (Sweden)

    Sherry L. Xie, Ph.D. Candidate

    2009-06-01

    Full Text Available Glaser’s term “compromised GT proposal” (2001, p.114 refers to the type of Grounded Theory (GT proposal that is written in order to conform to the requirements of a standardized qualitative research proposal. A GT proposal needs only to supply information on the area of interest, the data source and a statement of method to the effect that the researcher begin to collect, code and analyse the data and let the theory emerge. Thus, the proposal may only occupy “a page or two” (Glaser, 2001, p. 111. Whilst being consistent with the methodology, a GT proposal sometimes has to give way to the format specified by a PhD program or committee even though the format was not defined for a GT proposal and in some areas, conflicts with GT principles; for example, the format may require a literature review. This short paper reports on my experience of writing a compromised GT proposal as a first-time GT researcher. It describes how both Glaser’s advice on writing compromised GT research proposals and the characteristics of the substantive area of the proposed research were used to satisfy program requirements while still maintaining GT fundamentals.

  18. 78 FR 6273 - Rules Relating to Additional Medicare Tax

    Science.gov (United States)

    2013-01-30

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 31 [REG-130074-11] RIN 1545-BK54 Rules Relating to Additional Medicare Tax Correction In proposed rule document 2012-29237, appearing on pages 72268- 72277 in the issue of Wednesday, December 5, 2012, make the following correction...

  19. Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.

    Science.gov (United States)

    Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

    2017-10-01

    To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

    Science.gov (United States)

    Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

    2016-04-01

    To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

  1. Medicares Physician Quality Reporting System (PQRS)...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...

  2. Measuring Coding Intensity in Medicare Advantage - SUPP.

    Data.gov (United States)

    U.S. Department of Health & Human Services — In 2004, Medicare implemented a risk-adjustment system that pays Medicare Advantage (MA) plans based on diagnoses reported for their enrollees, giving the plans an...

  3. Identifiable Data Files - Medicare Provider Analysis and ...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) File contains data from claims for services provided to beneficiaries admitted to Medicare certified inpatient...

  4. Medicare Physician and Other Supplier Interactive Dataset

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data - Physician and Other...

  5. Medicare Current Beneficiary Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a representative national sample of the Medicare population. There are two...

  6. Beneficiary Activation in the Medicare Population

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Beneficiary Activation in the Medicare Population, published in Volume 4, Issue 4 of the Medicare and Medicaid Research Review,...

  7. Medicares Hospice Benefit - Analysis of Utilization and..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Descriptive analyses reported in Medicares Hospice Benefit - Analysis of Utilization and Resource Use, published in Volume 4, Issue 3 of the Medicare and Medicaid...

  8. Assessing Measurement Error in Medicare Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Assessing Measurement Error in Medicare Coverage From the National Health Interview Survey Using linked administrative data, to validate Medicare coverage estimates...

  9. Plan selection in Medicare Part D: Evidence from administrative data

    Science.gov (United States)

    Heiss, Florian; Leive, Adam; McFadden, Daniel; Winter, Joachim

    2014-01-01

    We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25 percent of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15 percent of expected total out-of-pocket cost for drugs and Part D insurance. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeable fraction of consumers place large values on plan features other than cost, they are not optimizing effectively. PMID:24308882

  10. 78 FR 59666 - Transmission Infrastructure Program; Proposed Transmission Infrastructure Program Updates and...

    Science.gov (United States)

    2013-09-27

    ... the Program to evaluate its current project development and financing practices and to identify areas... the conditions precedent required for a Project Applicant to apply for financing. Submitted after... involves the underwriting, financing, and loan monitoring and servicing for an Eligible Project. With few...

  11. 77 FR 5317 - Medicaid Program; Covered Outpatient Drugs

    Science.gov (United States)

    2012-02-02

    ... for Medicare & Medicaid Services 42 CFR Part 447 Medicaid Program; Covered Outpatient Drugs; Proposed... Part 447 [CMS-2345-P] RIN 0938-AQ41 Medicaid Program; Covered Outpatient Drugs AGENCY: Centers for... requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the...

  12. Outline of research proposals selected in the Nuclear Energy Research Initiative (NERI) program

    International Nuclear Information System (INIS)

    Iwamura, Takamichi; Okubo, Tsutomu; Usui, Shuji

    1999-08-01

    The U.S. Department of Energy (DOE) created a new R and D program called Nuclear Energy Research Initiative (NERI)' in FY 1999 with the appropriation of $19 million. The major objectives of the NERI program is to preserve the nuclear science and engineering infrastructure in the U.S. and to maintain a competitive position in the global nuclear market in the 21st century. In may, 1999, the DOE selected 45 research proposals for the first year of the NERI program. The proposals are classified into the following five R and D areas: Proliferation Resistant Reactors and/or Fuel Cycles, New Reactor Designs, Advanced Nuclear Fuel, New Technology for Management of Nuclear Waste, Fundamental Nuclear Science. Since the NERI is a very epoch-making and strategic nuclear research program sponsored by the U.S. government, the trend of the NERI is considered to affect the future R and D programs in Japanese nuclear industries and research institutes including JAERI. The present report summarizes the analyzed results of the selected 45 research proposals. Staffs comments are made on each proposal in connection with the R and D activities in JAERI. (author)

  13. Relationships between Medicare Advantage contract characteristics and quality-of-care ratings: an observational analysis of Medicare Advantage star ratings.

    Science.gov (United States)

    Xu, Peng; Burgess, James F; Cabral, Howard; Soria-Saucedo, Rene; Kazis, Lewis E

    2015-03-03

    The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses. To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings. Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics. CMS MA contracts nationally. 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010. The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction. Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P  star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries. None.

  14. Opioid Prescribing Practices of Neurosurgeons: Analysis of Medicare Part D.

    Science.gov (United States)

    Khalid, Syed I; Adogwa, Owoicho; Lilly, Daniel T; Desai, Shyam A; Vuong, Victoria D; Mehta, Ankit I; Cheng, Joseph

    2018-04-01

    The Centers for Disease Control have declared that the United States is amidst a continuing opioid epidemic, with drug overdose-related death tripling between 1999 and 2014. Among the 47,055 overdose-related deaths that occurred in 2014, 28,647 (60.9%) of them involved an opioid. The Part D Prescriber Public Use File, which is based on beneficiaries enrolled in the Medicare Part D prescription drug program, was used to query information on prescription drug events incurred by Medicare beneficiaries with a Part D prescription drug plan from 31 June 2014 to 30 June 2015. Only those providers with the specialty description of neurosurgeon, as reported on the provider's Part B claims, were included in this study. A total of 271,502 beneficiaries, accounting for 971,581 claims and 22,152,689 day supplies of medication, accounted for the $52,956,428.40 paid by the Centers for Medicare and Medicaid Services for medication that the 4085 neurosurgeons submitted to the Centers for Medicare and Medicaid Services Part D program in the 2014 calendar year. During the same year, 402,767 (41.45%) claims for 158,749 (58.47%) beneficiaries accounted for 6,458,624 (29.16%) of the day supplies of medications and $13,962,630.11 (26.37%) of the total money spent by the Centers for Medicare and Medicaid Services Part D that year. Nationwide, the ratio of opioid claims to total Medicare Part D beneficiaries was 1.48. No statistically significant regional differences were found. The opioid misuse epidemic is a complex and national issue with patterns of prescription not significantly different between regions. All neurosurgeons must be cognizant of their prescribing practices so as to best support the resolution of this public health crisis. Copyright © 2017. Published by Elsevier Inc.

  15. Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015.

    Science.gov (United States)

    Salerno, Amy M; Horwitz, Leora I; Kwon, Ji Young; Herrin, Jeph; Grady, Jacqueline N; Lin, Zhenqiu; Ross, Joseph S; Bernheim, Susannah M

    2017-07-13

    To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status. Admissions for Medicare fee-for-service patients, age ≥65 years, discharged alive, who had a valid five-digit zip code and did not have a principal discharge diagnosis of cancer or psychiatric illness were included, for a total of 52 516 213 index admissions. Mean hospital-level, all-condition, 30-day risk-adjusted standardised unplanned readmission rate, measured quarterly, along with quarterly rate of change, and an interrupted time series examining: April-June 2010, after HRRP was passed, and October-December 2012, after HRRP penalties were implemented. 58.0% (SD 15.3) of safety net hospitals and 17.1% (SD 10.4) of non-safety net hospitals' patients were in the lowest quartile of socioeconomic status. The mean safety net hospital standardised readmission rate declined from 17.0% (SD 3.7) to 13.6% (SD 3.6), whereas the mean non-safety net hospital declined from 15.4% (SD 3.0) to 12.7% (SD 2.5). The absolute difference in rates between safety net and non-safety net hospitals declined from 1.6% (95% CI 1.3 to 1.9) to 0.9% (0.7 to 1.2). The quarterly decline in standardised readmission rates was 0.03 percentage points (95% CI 0.03 to 0.02, preadmission rates for safety net hospitals have decreased more rapidly than those for non-safety net hospitals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries.

    Science.gov (United States)

    Bernhardt, Antonia K; Lynn, Joanne; Berger, Gregory; Lee, James A; Reuter, Kevin; Davanzo, Joan; Montgomery, Anne; Dobson, Allen

    2016-09-01

    At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with "activities of daily living." Available services fail to match frail elders' needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs. The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long-term care costs, and declining family caregiver availability portend gaps in badly needed services. The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. The

  17. Medicare program; revisions to payment policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, access to identifiable data for the Center for Medicare and Medicaid Innovation Models & other revisions to Part B for CY 2015. Final rule with comment period.

    Science.gov (United States)

    2014-11-13

    This major final rule with comment period addresses changes to the physician fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. See the Table of Contents for a listing of the specific issues addressed in this rule.

  18. Paying Medicare Advantage plans by competitive bidding: how much competition is there?

    Science.gov (United States)

    Biles, Brian; Pozen, Jonah; Guterman, Stuart

    2009-08-01

    Private health plans that enroll Medicare beneficiaries--known as Medicare Advantage (MA) plans--are being paid $11 billion more in 2009 than it would cost to cover these beneficiaries in regular fee-for-service Medicare. To generate Medicare savings for offsetting the costs of health reform, the Obama Administration has proposed eliminating these extra payments to private insurers and instituting a competitive bidding system that pays MA plans based on the bids they submit. This study examines the concentration of enrollment among MA plans and the degree to which firms offering MA plans actually face competition. The results show that in the large majority of U.S. counties, MA plan enrollment is highly concentrated in a small number of firms. Given the relative lack of competition in many markets as well as the potential impact on traditional Medicare, the authors call for careful consideration of a new system for setting MA plan payments.

  19. Medicare Special Needs Plan (SNP)

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  20. Medicare Preventive and Screening Services

    Science.gov (United States)

    ... Glossary MyMedicare.gov Login Search Main Menu , collapsed Main Menu Sign Up / Change Plans Getting started with ... setup: setupNotifier, notify: notify }; lrNotifier.setup(); $("#menu-btn, li.toolbarmenu .toolbarmenu-a").click(function() { // var isExpanded = ' is ...

  1. How To Prepare Program Proposals for the American Psychological Association Annual Convention.

    Science.gov (United States)

    Tentoni, Stuart C.

    The purpose of this paper is to dispel myths about preparing program proposals for the American Psychological Association's annual convention. The report's goal is to increase the number of student presenters at future annual conventions. It has been determined that, for a variety of reasons, psychology graduate students participate more in poster…

  2. 77 FR 43560 - American Indian Vocational Rehabilitation Services Program; Proposed Waivers and Extensions of...

    Science.gov (United States)

    2012-07-25

    ... Program; Proposed Waivers and Extensions of the Project Periods AGENCY: Office of Special Education and... rehabilitation services to American Indians with disabilities who reside on or near Federal or State reservations... documents published by the Department. Dated: July 19, 2012. Alexa Posny, Assistant Secretary for Special...

  3. 77 FR 57103 - Notice of Submission of Proposed Information Collection to OMB Housing Counseling Program

    Science.gov (United States)

    2012-09-17

    ... Proposed Information Collection to OMB Housing Counseling Program AGENCY: Office of the Chief Information... Counseling organizations submit information to HUD through Grants.gov when applying for grant funds to provide housing counseling assistance to eligible homebuyers to find and purchase affordable housing...

  4. 78 FR 79638 - Energy Conservation Program for Consumer Products: Proposed Determination of Hearth Products as a...

    Science.gov (United States)

    2013-12-31

    ... Conservation Program for Consumer Products: Proposed Determination of Hearth Products as a Covered Consumer... determined that hearth products qualify as a covered product under Part A of Title III of the Energy Policy and Conservation Act (EPCA), as amended. More specifically, DOE has tentatively determined that hearth...

  5. 75 FR 11327 - Proposed Establishment of Certification Programs for Health Information Technology

    Science.gov (United States)

    2010-03-10

    ... Certification Programs for Health Information Technology; Proposed Rule #0;#0;Federal Register / Vol. 75, No. 46... for Health Information Technology AGENCY: Office of the National Coordinator for Health Information... granted to the National Coordinator for Health Information Technology (the National Coordinator) by...

  6. 77 FR 13619 - Notice of Proposed Information for Public Comment for: Public Housing Capital Fund Program

    Science.gov (United States)

    2012-03-07

    ... that are not subject to Independent Public Accountant (IPA) audit requirements. Agency form numbers, if... Information for Public Comment for: Public Housing Capital Fund Program AGENCY: Office of the Assistant Secretary for Public and Indian Housing, HUD. ACTION: Notice. SUMMARY: The proposed information collection...

  7. Communicative Competence of the Fourth Year Students: Basis for Proposed English Language Program

    Science.gov (United States)

    Tuan, Vu Van

    2017-01-01

    This study on level of communicative competence covering linguistic/grammatical and discourse has aimed at constructing a proposed English language program for 5 key universities in Vietnam. The descriptive method utilized was scientifically employed with comparative techniques and correlational analysis. The researcher treated the surveyed data…

  8. 78 FR 15798 - 60-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting

    Science.gov (United States)

    2013-03-12

    ... DEPARTMENT OF STATE [Public Notice 8218] 60-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting ACTION: Notice of request for public comment. SUMMARY: The Department of State is seeking Office of Management and Budget (OMB) approval for the information collection described...

  9. Existing and Proposed Child Find Initiatives in One State's Part C Program

    Science.gov (United States)

    Edwards, Nicole Megan; Gallagher, Peggy A.; Green, Katherine B.

    2013-01-01

    Despite a Child Find mandate in IDEA, early detection and screening of infants and toddlers with special needs continues to remain an area in need of improvement. The authors sought to better understand existing and proposed outreach initiatives in one state's Part C Early Intervention (EI) program that ranks among the lowest nationally in the…

  10. 76 FR 29747 - State Program Requirements; Proposal To Approve Maine's Base National Pollutant Discharge...

    Science.gov (United States)

    2011-05-23

    ... of cooling water intake structures under CWA section 316(b). Authority: This action is proposed to be... the First Circuit vacated EPA's October 31, 2003 decision to withhold the permitting of two tribally..., 1999). Maine's application included an assertion of authority to implement the program in the...

  11. Guidelines For Implementation of Industrial Programs For Proposed Community Colleges in Venezuela.

    Science.gov (United States)

    Sada, Pablo Maria

    The purpose of this study was to examine selected industrial education departments and programs of the community colleges in the United States, and to draw some beneficial implications for the establishment of the proposed community colleges in Venezuela. The procedure involved a review of the literature, the construction of a questionnaire, and…

  12. Proposal of Modification Strategy of NC Program in the Virtual Manufacturing Environment

    Science.gov (United States)

    Narita, Hirohisa; Chen, Lian-Yi; Fujimoto, Hideo; Shirase, Keiichi; Arai, Eiji

    Virtual manufacturing will be a key technology in process planning, because there are no evaluation tools for cutting conditions. Therefore, virtual machining simulator (VMSim), which can predict end milling processes, has been developed. The modification strategy of NC program using VMSim is proposed in this paper.

  13. 78 FR 79654 - Vermont: Proposed Authorization of State Hazardous Waste Management Program Revisions

    Science.gov (United States)

    2013-12-31

    ...] Vermont: Proposed Authorization of State Hazardous Waste Management Program Revisions AGENCY... Docket ID No. EPA-R01- RCRA-2013-0554, by mail to Sharon Leitch, RCRA Waste Management and UST Section..., RCRA Waste Management and UST Section, Office of Site Remediation and Restoration (OSRR07-1), US EPA...

  14. The Abbott School Construction Program: NJ Department of Education Proposed Facilities Regulations. Analysis of Preschool Issues

    Science.gov (United States)

    Ponessa, Joan; Boylan, Ellen

    2004-01-01

    This report on preschool facilities analyzes regulations proposed by the New Jersey Department of Education (NJDOE) to implement the Educational Facilities Construction and Financing Act. (EFCFA). EFCFA, which authorizes and governs New Jersey's public school construction program, was enacted in July 2000 to implement the State Supreme Court's…

  15. The Proposed Model of Collaborative Virtual Learning Environment for Introductory Programming Course

    Science.gov (United States)

    Othman, Mahfudzah; Othman, Muhaini

    2012-01-01

    This paper discusses the proposed model of the collaborative virtual learning system for the introductory computer programming course which uses one of the collaborative learning techniques known as the "Think-Pair-Share". The main objective of this study is to design a model for an online learning system that facilitates the…

  16. Medicare home health utilization as a function of nursing home market factors.

    OpenAIRE

    Swan, J H; Benjamin, A E

    1990-01-01

    Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health u...

  17. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting

    Science.gov (United States)

    2017-08-04

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.

  18. An assessment of the water management program proposed in the Ranger EIS and its environmental implications

    International Nuclear Information System (INIS)

    Davy, D.R.

    1976-01-01

    An assessment of the water management program proposed in the Ranger EIS has three components: a) a statement of water quality criteria and standards that the program must meet, b) a set of calculations based on the best available estimates, that compares the expected levels of waste with the standards set for the release, c) the plan of the surveillance program aimed at demonstrating compliance with these standards and at revealing deficiencies in the choice of criteria, the derivation of standards from them and unforseen departures from expectation. Standards are suggested for the operation of the Ranger mines based on the most restrictive criterion out of: (i) acute toxicity tests carried out on organisms and water from the Magela Creek combined with application factors recommended by AWRC, (ii) the results on indicator species and biological diversity indices for the Finniss river, (iii) requirements for agricultural and pastoral use, (iv) the requirements for portable water. It is expected that the program proposed by Ranger will meet these standards and it is concluded that planning for a comprehensive environmental program is adequate. (author)

  19. 75 FR 19677 - Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare...

    Science.gov (United States)

    2010-04-15

    ... recommended using a standard that emphasizes the materiality of the requirements that sponsors must meet... commenters requested that CMS more clearly articulate the methodology it will apply to past performance... performance methodology available through publication in our manuals. We believe that the manuals provide us...

  20. 76 FR 21431 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

    Science.gov (United States)

    2011-04-15

    ... reflect provisions in the ACA which are already in effect. Table 2 lists the key changes. While these ACA...) (ACA) and make other changes to the regulations based on our experience in the administration of the... Professional and the Employment of a Medical Director (Sec. 422.562, Sec. 422.566, Sec. 423.562, and Sec. 423...

  1. 78 FR 31283 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Science.gov (United States)

    2013-05-23

    ... organizations and Part D sponsors to reduce administrative costs such as marketing costs, profits, and other... directly apply to Cost HMOs/CMPs (Cost Health Maintenance Organizations/Competitive Medical Plans), HCPPs... the benefits offered by Cost HMOs/CMPs and employers/unions offering HCPPs. We are finalizing our...

  2. 78 FR 12427 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Science.gov (United States)

    2013-02-22

    .... In essence, a Cost HMO/CMP or an HCPP that did not meet the minimum MLR requirement on the Part D... MLR provisions. Note that there also are terms defined in other sections of the Part 422 Subpart X and Part 423 Subpart X (for example, ``incurred claims'' is defined in Sec. 422.2420(b) and Sec. 423.2420(b...

  3. 77 FR 32407 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

    Science.gov (United States)

    2012-06-01

    ....100 as being effective January 1, 2013. We also inadvertently omitted references to several sections... with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can waive... the finding and the reasons therefore in the notice. Section 553(b) of the APA ordinarily requires a...

  4. 75 FR 32858 - Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare...

    Science.gov (United States)

    2010-06-10

    ... changes to Sec. 423.551 regarding changes in ownership during a PDP term of contract. In presenting these... Administrative Procedure Act (APA) (5 U.S.C. 553(b)). In addition, section 553(d) of the APA (5 U.S.C. 553(b... effective date if the Secretary finds, for good cause, that the notice and comment process is impracticable...

  5. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    Science.gov (United States)

    2012-08-31

    (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

  6. Draft report: a selection methodology for LWR safety R and D programs and proposals

    Energy Technology Data Exchange (ETDEWEB)

    Husseiny, A. A.; Ritzman, R. L.

    1980-03-01

    The results of work done to develop a methodology for selecting LWR safety R and D programs and proposals is described. A critical survey of relevant decision analysis methods is provided including the specifics of multiattribute utility theory. This latter method forms the basis of the developed selection methodology. Details of the methodology and its use are provided along with a sample illustration of its application.

  7. Environmental program planning for the proposed high-level nuclear waste repository at Yucca Mountain, Nevada

    International Nuclear Information System (INIS)

    1987-08-01

    This report was prepared to illustrate the policy and actions that the State of Nevada believe are required to assure that the quality of the environment is adequately considered during the course of the DOE work at the proposed high-level nuclear waste repository at Yucca Mountain. The report describes the DOE environmental program and the studies planned by NWPO to reflect the State's position toward environmental protection. 41 refs., 2 figs., 11 tabs

  8. Draft report: a selection methodology for LWR safety R and D programs and proposals

    International Nuclear Information System (INIS)

    Husseiny, A.A.; Ritzman, R.L.

    1980-03-01

    The results of work done to develop a methodology for selecting LWR safety R and D programs and proposals is described. A critical survey of relevant decision analysis methods is provided including the specifics of multiattribute utility theory. This latter method forms the basis of the developed selection methodology. Details of the methodology and its use are provided along with a sample illustration of its application

  9. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Science.gov (United States)

    2010-10-01

    ... Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior... SUPPLY PROGRAM Feasibility Studies § 404.51 Are proposed projects under the Rural Water Supply Program... the Reclamation's Rural Water Supply Program. This includes review under Executive Order 12322 to...

  10. Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2016-11-03

    This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

  11. Medicare Part D and Portfolio Choice.

    Science.gov (United States)

    Ayyagari, Padmaja; He, Daifeng

    2016-05-01

    This study evaluates the impact of medical expenditure risk on portfolio choice among the elderly. The risk of large medical expenditures can be substantial for elderly individuals and is only partially mitigated by access to health insurance. The presence of deductibles, copayments, and other cost-sharing mechanisms implies that medical spending risk can be viewed as an undiversifiable background risk. Economic theory suggests that increases in background risk reduce the optimal financial risk that an individual or household is willing to bear (Pratt and Zeckhauser 1987; Elmendorf and Kimball 2000). In this study, we evaluate this hypothesis by estimating the impact of the introduction of the Medicare Part D program, which significantly reduced prescription drug spending risk for seniors, on portfolio choice.

  12. 76 FR 60050 - Medicaid Program: Money Follows the Person Rebalancing Demonstration Program

    Science.gov (United States)

    2011-09-28

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicaid Program: Money Follows the Person Rebalancing Demonstration Program AGENCY: Centers for Medicare & Medicaid... Medicaid beneficiaries with disabling and chronic conditions from institutions into the community. The...

  13. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

    Science.gov (United States)

    ROBBINS, JACOB A.

    2015-01-01

    The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

  14. Proposal on application of Russian technical facilities for International Mars Research Program for 2009 2015

    Science.gov (United States)

    Polishchuk, Georgy; Pichkhadze, Konstantin; Vorontsov, Victor; Pavel, Kazmerchuk

    2006-07-01

    Recently International Mars Research Program is widely discussed. Well-known initiative of President of the USA, recent progress of American and European scientists and engineers in implementation of “Mars Odyssey” and “Mars-Express” projects and Russian proposals on cooperation and participation in “Phobos Sample Return” mission declare every intention to join efforts in the ambitious Martian Program realization. The final goal of the program for nearly 15 20 years is landing of a man on the Martian surface. Before this event happens another critical stage will be Martian soil sample return. Within the next 10 years, apparently, a major task will be scale research by means of various types of technical facilities. A crucial issue for this research will be creation of research station network which would allow collecting information about planetary conditions at far-remote points. By this time within the frame of “Phobos Sample Return Program” to be launched in 2009 it is planned to deliver some meteorological mini-landers developed by the Russian and Finnish specialists on the Martian surface. From this point view it is also interesting to use balloons capable to cover considerable distance. Such proposals have been made by Russian side for “Scout” mission. European “Aurora” program also anticipates application of wide range of technical means to explore the Martian atmosphere and surface including inflatable devices. Thus, for the International Mars Exploration Program, it seems to be very prospective to use apart from launch vehicles, upper stages etc. such technical means as mini-stations, Mars rovers, penetrators, balloons, etc.

  15. Model citizens. Outsourcing helps start-up Medicare HMO.

    Science.gov (United States)

    Slavic, B; Adami, S

    1999-04-01

    Health Plans of Pennsylvania (HPP), the managed care arm of Crozer-Keystone Health System, in Media, Pa. Selecting the information systems and building the infrastructure to support the start-up of a new Medicare HMO product. HPP chose to outsource the information systems needed to integrate all the components of managed care administration into a cost-effective and cohesive program. Because of its aggressive programming and start-up of the MedCarePlus product offering, HPP became the first plan in the country to submit Medicare claims data electronically for encounter reporting to the Health Care Financing Administration (HCFA). "Through an integrated team approach, an organization truly can benefit from the economies of scale gained through outsourcing."

  16. Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies.

    Science.gov (United States)

    Zheng, Nan Tracy; Haber, Susan; Hoover, Sonja; Feng, Zhanlian

    2017-12-01

    Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service. © Health Research and Educational Trust.

  17. The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.

    Science.gov (United States)

    Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

    2018-04-01

    To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation. © Health Research and Educational Trust.

  18. Making didactics proposals aimed at improving socioeducational programs for youngters at risk of social exclusion

    Directory of Open Access Journals (Sweden)

    María Violeta Álvarez Fernández

    2013-12-01

    Full Text Available Educators at Sograndio Juvenile Detention Center in Asturias were sure that they were able to offer new alternatives to improve their socio-educational intervention. That is the reason why they got involved in an action research training process aimed at making didactic proposals which tried to optimize the development of social competence programs for youngsters with criminal behavior. In order to do this, the Short Version of the Prosocial Thinking Program for Young People (Alba et al., 2005 was applied to nine inmates, eight males between 14 and 20 years old and a female of 16 years old. Theywere the basis and reflection of ourmethodological intervention. The teamtaking part in this intervention is formed by nine inmates and three external members (two coordinators and a woman psychologist. The investigation, mainly qualitative, includes different instruments (both qualitative and quantitative, such as: observation registries, discussion groups, questionnaires and notebooks. After the implementation of the program, positive changes must be highlighted in the emotional dimension, the resolution of problems, self-control and frustration tolerance. Besides, very high levels of satisfaction have been observed among youngsters, educators and external informants. It is important to have created a climate of professional compromise towards change and this way to have abandoned a passive attitude towards training, so that we were able to start an active search for practical answers, adjusted to our necessities and professional interests. Finally, we make several observations and intervention proposals that contribute to generate didactic knowledge thought and adapted for social education.

  19. Medicare payments to the neurology workforce in 2012.

    Science.gov (United States)

    Skolarus, Lesli E; Burke, James F; Callaghan, Brian C; Becker, Amanda; Kerber, Kevin A

    2015-04-28

    Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.

  20. Proposal to introduce Disaster Risk Management topics in Master programs in ESAN Graduate School of Business

    Directory of Open Access Journals (Sweden)

    CECILIA DEJO ESTEVES

    Full Text Available This paper aims to explain and present a proposal to introduce Disaster Risk Management (DRM topics into ESAN Graduate School of Business Master's programs. Although disasters have cost Peru more than USD 7,600 million in the past 2 decades the business sector, particularly Small and Medium Enterprises, have not developed preventive or continuity plans mainly because they are not familiar with DRM topics. Taking this into consideration, the paper presents a detailed academic/curricular proposal for DRM topics such as business continuity, business ethics, corporate social responsibility, and sustainable management. Additionally, it introduces the idea of promoting Disaster Risk Management (DRM topics to the Peruvian business community as a strategy to enhance the graduate education.

  1. Curricular renovation in the phonoaudiology program of the University of Cauca: a proposal for educational quality

    Directory of Open Access Journals (Sweden)

    Liliana María Pérez-Tenorio

    2010-09-01

    Full Text Available In Colombia, the Superior Education is going through a transformation process. These changes must be in coherence with the formulation of flexible policies among the diverse components of the curriculum and with the need for new forms of working and producing knowledge. The curricular renovation must ref lect an educational quality compromise and contribute to generate human development with high social impact. This article presents a proposal for Curricular Renovation, elaborated by faculty and students of the Phonoaudiology Program of the University of Cauca. This document contains aspects related to the pedagogic model, didactics, faculty-student relation, systems of evaluation and plan of studies. Furthermore, in this document the bases for the Route of Curricular Renovation are presented, consisting of the following phases: background, diagnosis and operational plan. These should facilitate the academic integration for adjusting the curricular processes to the needs of the academic program in a local, national and international context.

  2. Intertechnology Corporation proposed test and evaluation plan, commercial buildings. National Solar Demonstration Program

    Energy Technology Data Exchange (ETDEWEB)

    None

    1976-09-01

    This report has three major parts. The first of these derives the requirements for the Test and Evaluation plan from the System Level Plan which is summarized in Section II. The second part contains the proposed plan to fill these requirements and includes hardware and software recommendations as well as procedures and management considerations. Primary emphasis has been given to the remote site because this is the area in which the commercial part of the demonstration is most unique. Finally, some pre-demonstration activities are described. The pilot program is intended to resolve a number of issues which arose in the course of the T and E plan. These relate to choice of scan frequencies, compression algorithms, etc. It is also intended to confirm performance and cost effectiveness of the site data collection package. The base line measurements of attitudes, etc. provide a reference mark against which one can measure the non-technical effectiveness of the demonstration program. (WDM)

  3. The Medicare Annual Wellness Visit.

    Science.gov (United States)

    Colburn, Jessica L; Nothelle, Stephanie

    2018-02-01

    The Medicare Annual Wellness Visit is an annual preventive health benefit, which was created in 2011 as part of the Patient Protection and Affordable Care Act. The visit provides an opportunity for clinicians to review preventive health recommendations and screen for geriatric syndromes. In this article, the authors review the requirements of the Annual Wellness Visit, discuss ways to use the Annual Wellness Visit to improve the care of geriatric patients, and provide suggestions for how to incorporate this benefit into a busy clinic. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. General Electric Company proposed test and evaluation plan, commercial buildings. National Solar Demonstration Program

    Energy Technology Data Exchange (ETDEWEB)

    None

    1976-04-01

    The general requirements and methods for instrumenting, testing, and evaluating solar HVAC systems forming a part of ERDA's ''Commercial Demonstration Program'' commensurate with ERDA 23A and the Proposed Management Plan 75SDS4270 are defined. Design requirements are specified for the performance of components and subsystems comprising the instrumentation and data gathering system, as well as the support functions required to perform the diagnostic measurements, collection and processing of data, and documentation of reports on solar HVAC system performance, including economic and societal evaluations.

  5. Identification of Barriers Towards Change and Proposal to Institutionalize Continuous Improvement Programs in Manufacturing Operations

    Directory of Open Access Journals (Sweden)

    Alvair Silveira Torres Jr.

    2011-06-01

    Full Text Available A multi case research unfolded into a study in a sample of Brazilian manufacturing companies concerning their Continuous Improvement (CI program in manufacturing operations. Stakeholders interviews and performance analyses were conducted. The study aims to analyze the existence or absence of the institutionalization of a CI culture in manufacturing operations, identify barriers and difficulties within the process and propose a model for change. As a result of the research, it was observed that despite the considerable motivation of staff, rapid gains of the company and superior results during the early phases of the CI program, time and again such results were either not upheld or faded out over time, delivering no significant mid-term or long term results, due to poor management of changes. This happened mainly as a result of lack of strategic alignment at all levels of the organization, translated in measureable activities and projects, coached and mentored by the middle and upper management throughout the implementation and maintenance of the program. The selected cases showed a declining in performance after two years of CI program start up. Learning, union and process ownership among participants by means of interactions, are necessary to absorb and incorporate changes, instead of merely "smart words" .

  6. Views of surgery program directors on the current ACGME and proposed IOM duty-hour standards.

    Science.gov (United States)

    Willis, Ross E; Coverdill, James E; Mellinger, John D; Collins, J Craig; Potts, John R; Dent, Daniel L

    2009-01-01

    The purpose of this study was to survey the experiences of surgery program directors with the current Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards and views of the Institute of Medicine (IOM) proposed duty-hour recommendations. A total of 118 program directors (47.6% of all surgery programs in the US) responded to the survey. Results showed that the current duty-hour standards have hindered clinical education opportunities by reducing or eliminating rotations on many services, didactic teaching conferences, and clinical bedside teaching opportunities. Additionally, patient safety has been compromised by frequent hand offs of care. Most IOM recommendations were perceived as extremely difficult or impossible to implement, with the exception of the moonlighting recommendation. The results indicated that adopting the IOM recommendations is not feasible given current workforce limitations, and most program directors supported maintaining the current duty-hour standards until such time as there is evidence-based outcomes research to direct change. The conclusion was that the current ACGME duty-hour standards have reduced teaching opportunities and narrowed the scope of training.

  7. A proposal for an international program to develop dry recycle of spent nuclear fuel

    International Nuclear Information System (INIS)

    Feinroth, H.

    1999-01-01

    The dry oxidation-reduction process (called OREOX for Oxidation Reduction of Oxide Fuel) being developed by Korea and Canada, in cooperation with IAEA and the US State Department, is limited to recycle of spent LWR fuel into CANDU reactors (DUPIC). When first conceived and demonstrated via irradiation of test elements by Atomics International in 1965, (the process was called AIROX at that time) a wider range of applications was intended, including recycle of spent LWR fuel into LWRs. Studies sponsored by DOE's Idaho Office in 1992 confirmed the applicability of this technology to regions containing LWR's only, and described the potential advantages of such recycle from an environmental, waste management and economic point of view, as compared to the direct disposal option. Recent analyses conducted by the author indicates that such dry recycle may be one of the few acceptable paths remaining for resolution of the US spent fuel storage dilemma that remains consistent with US non-proliferation policy. It is proposed that a new US program be established to develop AIROX dry recycle for use in the US, and this become part of an international cooperative program, including the current Canadian - Korean program, and possibly including participation of other countries wishing to pursue alternatives to the once through cycle, and wet reprocessing. With shared funding of major project elements, such international cooperation would accelerate the demonstration and commercial deployment of dry recycle technology, as compared to separate and independent programs in each country. (author)

  8. 75 FR 43167 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Science.gov (United States)

    2010-07-23

    ...: Health Insurance Benefit Agreement; Use: Applicants to the Medicare program are required to agree to... for initiating and expanding health insurance coverage for uninsured children. States are also... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document...

  9. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Program Federal Legislation Federal Legislation Federal Legislation Health Care Reform Summary Letters on Health Care Reform Medicare Physician Payment Medical Liability Reform Opioids ...

  10. Paying Medicare Advantage Plans: To Level or Tilt the Playing Field

    Science.gov (United States)

    Glazer, Jacob; McGuire, Thomas G.

    2017-01-01

    Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and makes a subsidy payment to an MA plan based on a “benchmark” for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Presently, about 30% of beneficiaries are in MA, and Medicare subsidizes MA plans more on average than TM. Many analysts recommend equalizing Medicare’s subsidy across the options – referred to in policy circles as a “level playing field.” This paper studies the normative question of how to set the level of the benchmark, applying the versatile model of plan choice developed by Einav and Finkelstein (EF) to Medicare. The EF framework implies unequal subsidies to counteract risk selection across plan types. We also study other reasons to tilt the field: the relative efficiency of MA vs. TM, market power of MA plans, and institutional features of the way Medicare determines subsidies and premiums. After review of the empirical and policy literature, we conclude that in areas where the MA market is competitive, the benchmark should be set below average costs in TM, but in areas characterized by imperfect competition in MA, it should be raised in order to offset output (enrollment) restrictions by plans with market power. We also recommend specific modifications of Medicare rules to make demand for MA more price elastic. PMID:28318667

  11. 77 FR 47489 - 30-Day Notice of Proposed Information Collection: Form DS-4213, PEPFAR Program Expenditures; OMB...

    Science.gov (United States)

    2012-08-08

    ... provide key information about program costs under PEPFAR on a global level. Applying expenditure results... monitoring, the PEPFAR Finance and Economics Work Group proposes to add reporting of expenditures by program... from implementing partners in countries with PEPFAR programs using a standard tool (DS-4213) via an...

  12. Proposed Social Spending Innovation Research (SSIR) Program: Harnessing American Entrepreneurial Talent to Solve Major U.S. Social Problems

    Science.gov (United States)

    Coalition for Evidence-Based Policy, 2015

    2015-01-01

    The Social Spending Innovation Research (SSIR) proposal seeks to replicate, in social spending, the great success of the Small Business Innovation Research (SBIR) program in technology development. The SBIR program funds technology development by entrepreneurial small companies. The program has spawned breakthrough technologies in diverse areas…

  13. 77 FR 69550 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2012-11-19

    ... (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request AGENCY.... DeBakey Home Care Program. DATES: Written comments and recommendations on the proposed collection of...: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number...

  14. 75 FR 77607 - Privacy Act of 1974; Proposed New System of Records; Veterinary Medicine Loan Repayment Program

    Science.gov (United States)

    2010-12-13

    ...; Proposed New System of Records; Veterinary Medicine Loan Repayment Program AGENCY: National Institute of..., ``Veterinary Medicine Loan Repayment Program Records System, USDA/NIFA-1.'' This newly established system will... Sherman; National Program Leader, Veterinary Science; National Institute of Food and Agriculture...

  15. 75 FR 1408 - Pick-Sloan Missouri Basin Program, Eastern and Western Division Proposed Project Use Power Rate

    Science.gov (United States)

    2010-01-11

    ... of Proposed Pick-Sloan Missouri Basin Program, Eastern and Western Divisions, Project Use Power Rate...) for Project Use Power for the Pick-Sloan Missouri Basin Program (P-SMBP), Eastern and Western... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Pick-Sloan Missouri Basin Program, Eastern and...

  16. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

    Science.gov (United States)

    Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

    2017-06-01

    In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.

  17. Proposal of a Methodology of Stakeholder Analysis for the Brazilian Satellite Space Program

    Directory of Open Access Journals (Sweden)

    Mônica Elizabeth Rocha de Oliveira

    2012-03-01

    Full Text Available To ensure the continuity and growth of space activities in Brazil, it is fundamental to persuade the Brazilian society and its representatives in Government about the importance of investments in space activities. Also, it is important to convince talented professionals to place space activities as an object of their interest; the best schools should also be convinced to offer courses related to the space sector; finally, innovative companies should be convinced to take part in space sector activities, looking to returns, mainly in terms of market differentiation and qualification, as a path to take part in high-technology and high-complexity projects. On the one hand, this process of convincing or, more importantly, committing these actors to space activities, implies a thorough understanding of their expectations and needs, in order to plan how the system/organization can meet them. On the other hand, if stakeholders understand how much they can benefit from this relationship, their consequent commitment will very much strengthen the action of the system/organization. With this framework in perspective, this paper proposes a methodology of stakeholder analysis for the Brazilian satellite space program. In the exercise developed in the article, stakeholders have been identified from a study of the legal framework of the Brazilian space program. Subsequently, the proposed methodology has been applied to the planning of actions by a public organization.

  18. Seminar program for postgraduate specialty training in general practice: proposal for a 5-year thematic catalogue

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    Sommer, Susanne

    2017-11-01

    Full Text Available Introduction: In different German regions, seminar programs have been conducted for General practice residents. In each region, selection and teaching of learning content is conducted in a different manner. So far, no structured, standardized curriculum has been implemented nationwide. We have investigated, if the development of a common 5-year program of learning topics is conceivable between the different university departments of General practice in Germany.Method: The seminar program working group of the DEGAM (German College of General Practitioners and Family Physicians has conducted an online survey based on information gathered via preliminary telephone conference (n=7; physicians with postgraduate teaching experience among all German university departments of General Practice and two non-university teaching institutions, identified via the internet. 884 topics were extracted from 14 Seminar programs. The topics were entered in a database, discussed and categorized: Practice management/practice work flow/standardized documentation forms/quality management (n=33 topics, common acute and chronic diseases, including disease management programs (n=29 topics, communication, neurological, psychological and psychiatric consultations (n=24 topics, common medical problems, including eye, ear, nose, throat, skin and pediatric problems (n=99 Topics family physicians general approach, including epidemiology, shared decision making, test of time (n=42 Topics. These topics have been rated for priority and desirable number of teaching-units.Results: A catalogue of 111 topics was designed, encompassing 160 teaching units. There is a suggestion of wide topics collections plus an add-on catalogue.Conclusion: A proposal for a 5-year-thematic catalogue for postgraduate training of general practice residents in Germany has been developed. This newly developed curriculum has the potential to improve knowledge and skills that have not been covered during in

  19. THE PROPOSED MODEL OF COLLABORATIVE VIRTUAL LEARNING ENVIRONMENT FOR INTRODUCTORY PROGRAMMING COURSE

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    Mahfudzah OTHMAN

    2012-01-01

    Full Text Available This paper discusses the proposed model of the collaborative virtual learning system for the introductory computer programming course which uses one of the collaborative learning techniques known as the “Think-Pair-Share”. The main objective of this study is to design a model for an online learning system that facilitates the collaborative learning activities in a virtual environment such as online communications and pair or small group discussions. In order to model the virtual learning environment, the RUP methodology has been used where it involves the data collection phase and the analysis and design phase. Fifty respondents have been randomly selected to participate in the data collection phase to investigate the students’ interest and learning styles as well as their learning preferences. The results have shown the needs for the development of online small group discussions that can be used as an alternative learning style for programming courses. The proposed design of the virtual learning system named as the Online Collaborative Learning System or OCLS is being depicted using the object-oriented models which are the use-case model and class diagram in order to show the concise processes of virtual “Think-Pair-Share” collaborative activities. The “Think-Pair-Share” collaborative learning technique that is being used in this model has been chosen because of its simplicity and relatively low-risk. This paper also presents the proposed model of the system’s architecture that will become the guidelines for the physical development of OCLS using the web-based applications.

  20. [The Purpose of Medical Education: Proposal to Standardize a System of Credits for Medical Specializations Programs].

    Science.gov (United States)

    Cañar, Carlos Andrés Pineda

    2012-01-01

    This article analyzes the concept of an academic credit system and proposes a way to systematize medical specialization programs. The credit system is a way to recognize and standardize the total time that a student must devote to their training. Thus, a credit equal to a certain number of hours of classroom training and independent activities is proposed. An educational program is expressed in the number of credits needed for the whole training process to achieve the competencies expected. A review of the concept of competition in education is also performed. The introduction of the term and its relation to the need to measure performance in future professionals according to labor market needs is identified. A critical discussion about skills defining the different types of skills in the educational field is later discussed. Subsequently, the Colombian regulatory framework is presented concerning the powers, in particular, Decree 1295 of 2010, which defines one academic credit equal to 48 hours in a semester, of which 16 hours are classroom and 32 hours are independent study. A tor of the major milestones in the history of medical education is later made. The structure of credits and contact hours, independent of postgraduate psychiatry in the country is reviewed showing the heterogeneity in their approach. The proposal is presented, defining the types of classroom activities and how to calculate the hours of independent study by type of classroom activity. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.